Abstract
Introduction
With the increasing burden of geriatric population in India, TKR is a very common procedure done these days. But as compared to western population the expectations of the people are different in our country. Indian patients want to sit cross legged and squat but can tolerate pain and limp better. So our population has different satisfaction levels after surgery. Keeping this in mind, post op evaluation should also include the performance as well as satisfaction levels. The factors affecting these parameters need to be studied. The current trend is to operate on younger people with more life expectancy and lesser co-morbidities but they have higher demands. Thus it is important to follow TKR patients for an extended time and to study their performance and satisfaction levels and the effect of pre op factors on these parameters.
Objectives
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To evaluate the patient's satisfaction in terms of postoperative pain and functional outcome
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To identify preoperative characteristics predicting the postoperative outcome
MATERIAL AND METHOD
A study was done to analyse the satisfaction level, physical activity and quality of life after one year of TKR surgery using KOOS scoring system and DMC&H General Patient Questionnaire. Clinical data was recorded and a Performa was filled of 104 patients with 152 cemented total knee arthroplasty operated from June 2010 till December 2012 of who consented and underwent surgery at Dayanand Medical College & Hospital Ludhiana (India). Out of these, 56 were unilateral and 48 were bilateral cases.
Results
There was a significant improvement in means of all the five KOOS subscale scores but mean difference of the pre op and post op KOOS sports/recreational scores was low as compared to other four subscales. There was no significant effect of sex, duration of symptoms, number of co-morbidities and BMI on post op KOOS outcome scores and patient's satisfaction. Younger age group patients had higher post op KOOS scores but older age group patients had higher post op satisfaction levels. Patients undergoing simultaneous bilateral TKR had higher post op KOOS scores and higher satisfaction levels as compared to patients undergoing unilateral TKR. Patients with higher preop functional and KOOS scores also had better postop satisfaction levels. Mean postoperative KOOS Scores had trend of higher scores in OA patients as compared to RA patients. Post op KOOS pain and ADL scores were comparable to patient's satisfaction level83.7% patients had excellent satisfaction level, 12.5% good, 1.9% fair and 1.9% poor satisfaction one year after surgery.
CONCLUSION
Total knee replacement significantly improves patient's pain, symptoms, function and activities of daily living and knee related quality of life. Characters like sex, duration of symptoms, number of co-morbidities and BMI do not significantly affect the outcome. However, preop diagnosis, higher preoperative KOOS score, simultaneous bilateral replacements had possitive effect on postoperative KOOS score and satisfaction levels after 1 year follow up. In younger patients KOOS score improvement was better but satisfaction levels were lower
