Total knee arthroplasty (TKA) is considered as one of the most successful and cost-effective medical interventions yet it is consistently reported that up to 20% of patients are dissatisfied with their outcomes. Patient satisfaction is correlated with the fulfillment of expectations and an important aspect of this involves good surgeon-patient communication, which itself is a contributor to TKA satisfaction. The purpose of this study was to develop and test a checklist intended to enhance the quality of surgeon-patient communication by optimizing the surgeon's role in helping patients set (or reset) and manage post-TKA expectations that are realistic, achievable, and most importantly, patient-specific.

In this prospective mixed methods study, a communication checklist was developed from the analysis of interviews with patients who were between six weeks and six months post-TKA. Four orthopaedic surgeons then used the checklist to guide discussions with patients about post-operative expectations and outcomes during follow-up visits between six weeks and six months. A visual analogue scale was used to survey two groups of patients on five measures of satisfaction: the standard of care communication group and the intervention group who had received the checklist. The mean scores of the two groups were compared using independent t-tests. The duration of follow-up visits was also tracked to determine if the checklist took significantly more time in practice.

Themes from the qualitative analysis of eight patient interviews incorporated into the checklist included pain management, medication, physiotherapy, and general concerns and questions. The quantitative study comprised 127 participants, 67 in the standard of care communication group and 60 in the checklist group. There were no significant group differences in gender, BMI, comorbidities, post-operative complications, marital or occupational status, however the standard of care group was older by six years (p < .001). The checklist group reported significantly greater satisfaction on four of the five measures of satisfaction: TKA satisfaction and expectations met (p = .017), care and concern shown by the surgeons (p = .011), surgeons' communication ability (p = .008), and satisfaction with time surgeons spent with patients during follow-up visits (p < .001). Satisfaction with the TKA for relieving pain and restoring function was not significant (p = .064). Although the checklist increased the average clinic visit time by only 1 minute, 51 seconds, it was significantly greater (p = .001). The impact of age and gender on satisfaction was explored using a two-way analysis of variance. No significant effects or interactions were observed.

Checklists have been shown to decrease medical errors and improve overall standards of patient care but no published research to date has used a communication checklist to enhance orthopaedic surgeon-patient communication. The present findings indicate that this simple tool can significantly increase patient satisfaction. This has practical significance because patient satisfaction is a metric that is increasingly used as a key performance indicator for surgeons and health care institutions alike. Increased TKA satisfaction will benefit patients, surgeons, and the health care system overall.

INTRODUCTION

Patient-reported satisfaction is a critical measure in understanding the clinical success of total knee arthroplasty. Yet, satisfaction levels in TKA patients are generally lower than THA patients; and surgeon-patient agreeability regarding clinical success is typically in discordance. Thus, the purpose of this evaluation was to report on the one-year satisfaction data of a group of sensor-assisted TKA patients, and compare that data to the average satisfaction reported in literature, as measured by a meta-analysis.

Computer aided Total Hip Arthroplasty (THA) surgery is known to improve implantation precision, but clinical trials have failed to demonstrate an improvement in survivorship or patient reported outcome measures (PROMs). Our aim was to compare the risk of revision, PROMs and satisfaction rates between computer guided and THA implanted without computer guidance.

We used the National Joint Registry dataset and linked PROMs data. Our sample included THAs implanted for osteoarthritis using cementless acetabular components from a single manufacturer (cementless and hybrid). An additional analysis was performed limiting the sample size to THAs using cementless stems (fully cementless). The primary endpoint was revision (of any component) for any reason. Kaplan Meier survivorship analysis and an adjusted Cox Proportional Hazards model were used.

41683 non computer guided, and 871 (2%) computer guided cases were included in our cementless and hybrid analysis. 943 revisions were recorded in the non-guided and 7 in the computer guided group (adjusted Log-rank test, p= 0.028). Cumulative revision rate at 10 years was 3.88% (95%CI: 3.59 – 4.18) and 1.06% (95%CI: 0.45 – 2.76) respectively. Cox Proportional Hazards adjusted HR: 0.45 (95%CI: 0.21 – 0.96, p=0.038). In the fully cementless group, cumulative revision rate at 10 years was 3.99% (95%CI: 3.62 – 4.38) and 1.20% (95%CI: 0.52 – 3.12) respectively. Cox Proportional Hazards adjusted HR: 0.47 (95%CI: 0.22 – 1.01, p=0.053). There was no statistically significant difference in the 6-month Oxford Hip Score, EQ-5D, EQ-VAS and success rates. Patient Satisfaction (single-item satisfaction outcome measure) was improved in the computer guided group but this finding was limited by a reduced number of responses.

In this single manufacturer acetabular component analysis, the use of computer guided surgery was associated with a significant reduction in the early risk of revision. Causality cannot be inferred in view of the observational nature of the study, and further database and prospective studies are recommended to validate these findings.