Aims. Meeting preoperative expectations is known to be of major influence on postoperative satisfaction after total knee arthroplasty (TKA). Improved management of expectation, resulting in more realistic expectations can potentially lead to higher postoperative satisfaction. The objective of this study was to assess the effect of an additional preoperative education module, addressing realistic expectations for long-term functional recovery, on postoperative satisfaction and expectation fulfilment. Methods. In total, 204 primary TKA patients with osteoarthritis were enrolled in this randomized controlled trial (RCT). Patients were allocated to either usual preoperative education (control group) or usual education plus an additional module on realistic expectations (intervention group). Primary outcome was being very satisfied (numerical rating scale for satisfaction ≥ 8) with the treatment result at 12 months' follow-up. Other outcomes were change in preoperative expectations and postoperative expectation fulfilment. Results. A total of 187 patients (91.7%) were available for analysis at follow-up. In the intention-to-treat analysis, 58.5% (55/94) of patients were very satisfied with the treatment result in the control group, and 69.9% (65/93) of patients in the intervention group (adjusted odds ratio (AOR) 1.72, 95% confidence interval (CI) 0.90 to 3.29). A per-protocol analysis for patients who attended the education session (92.0%, n = 172) showed that 56.9% (49/86) of patients were very satisfied in the control group and 74.4% (61/86) in the intervention group (AOR 2.44, 95% CI 1.21 to 4.91). After preoperative education, the expectation scores in the intervention group were significantly lower (mean difference -6.9 (95% CI -10.2 to -3.6)) and did not alter in the control group (mean difference 0.5 (95% CI -2.9 to 3.9)). Overall, fulfilment of expectations at 12 months was significantly higher in the intervention group (mean difference 11.4% (95% CI 2.3 to 20.5)). Conclusion. Improved preoperative patient education can modify patient expectations, resulting in higher postoperative fulfilment of expectation and higher satisfaction in the group that attended the preoperative education. This is the first RCT to confirm the potential of improved expectation management on satisfaction after TKA. Cite this article: Bone Joint J 2021;103-B(4):619–626

Aims. While patients with psychological distress have poorer short-term outcomes after total knee arthroplasty (TKA), their longer-term function is unknown. We aimed to 1) assess the influence of preoperative mental health status on long-term functional outcomes, quality of life, and patient satisfaction; and 2) analyze the change in mental health after TKA, in a cohort of patients with no history of mental health disorder, with a minimum of ten years’ follow-up. Methods. Prospectively collected data of 122 patients undergoing primary unilateral TKA in 2006 were reviewed. Patients were assessed pre- and postoperatively at two and ten years using the Knee Society Knee Score (KSKS) and Function Score (KSFS); Oxford Knee Score (OKS); and the Mental (MCS) and Physical Component Summary (PCS) which were derived from the 36-Item Short-Form Health Survey questionnaire (SF-36). Patients were stratified into those with psychological distress (MCS < 50, n = 51) and those without (MCS ≥ 50, n = 71). Multiple regression was used to control for age, sex, BMI, Charlson Comorbidity Index (CCI), and baseline scores. The rate of expectation fulfilment and satisfaction was compared between patients with low and high MCS. Results. There was no difference in the mean KSKS, KSFS, OKS, and SF-36 PCS at two years or ten years after TKA. Equal proportions of patients in each group attained the minimal clinically important difference for each score. Psychologically distressed patients had a comparable rate of satisfaction (91.8% (47/51) vs 97.1% (69/71); p = 0.193) and fulfilment of expectations (89.8% vs 97.1%; p = 0.094). The proportion of distressed patients declined from 41.8% preoperatively to 29.8% at final follow-up (p = 0.021), and their mean SF-36 MCS improved by 10.4 points (p < 0.001). Conclusion. Patients with poor mental health undergoing TKA may experience long-term improvements in function and quality of life that are comparable to those experienced by their non-distressed counterparts. These patients also achieved a similar rate of satisfaction and expectation fulfilment. Undergoing TKA was associated with improvements in mental health in distressed patients, although this effect may be due to residual confounding. Cite this article: Bone Joint J 2020;102-B(7):845–851

Pre-operative variables are increasingly being used to determine eligibility for total knee replacement (TKR). This study was undertaken to evaluate the relationships, interactions and predictive capacity of variables available pre- and post-operatively on patient satisfaction following TKR. Using nationally collected patient reported outcome measures and data from the National Joint Registry for England and Wales, we identified 22 798 patients who underwent TKR for osteoarthritis between August 2008 and September 2010. The ability of specific covariates to predict satisfaction was assessed using ordinal logistic regression and structural equational modelling. Only 4959 (22%) of 22 278 patients rated the results of their TKR as ‘excellent’, despite the majority (71%, n = 15 882) perceiving their knee symptoms to be much improved. The strongest predictors of satisfaction were post-operative variables. Satisfaction was significantly and positively related to the perception of symptom improvement (operative success) and the post-operative EuroQol-5D score. While also significant within the models pre-operative variables were less important and had a minimal influence upon post-operative satisfaction. The most robust predictions of satisfaction occurred only when both pre- and post-operative variables were considered together. These findings question the appropriateness of restricting access to care based on arbitrary pre-operative thresholds as these factors have little bearing on post-operative satisfaction. Cite this article: Bone Joint J 2013;95-B:1359–65

Satisfaction is increasingly employed as an outcome measure for a successful total knee replacement (TKR). Satisfaction as an outcome measure encompasses many different intrinsic and extrinsic factors related to a person’s experience before and after TKR. The Swedish Knee Arthroplasty Registry has previously demonstrated on a large population study that 17% of TKR recipients are not satisfied with their TKR outcome. This finding has been replicated in other countries. Similar significant factors emerged from these registry studies that are related to satisfaction. It would appear that satisfaction is better after more chronic diseases and whether the TKR results in pain relief or improved function. Importantly, unmet pre-operative expectations are a significant predictor for dissatisfaction following a TKR. It may be possible to improve rates by addressing the issues surrounding pain, function and expectation before embarking on surgery. Cite this article: Bone Joint J 2013;95-B, Supple A:148–52

This study assessed the effect of concomitant back pain on the Oxford knee score (OKS), Short-Form (SF)-12 and patient satisfaction after total knee replacement (TKR). It involved a prospectively compiled database of demographics and outcome scores for 2392 patients undergoing primary TKR, of whom 829 patients (35%) reported back pain. Compared with those patients without back pain, those with back pain were more likely to be female (odds ratio (OR) 1.5 (95% confidence interval (CI) 1.3 to 1.8)), have a greater level of comorbidity, a worse pre-operative OKS (2.3 points (95% CI 1.7 to 3.0)) and worse SF-12 physical (2.0 points (95% CI 1.4 to 2.6)) and mental (3.3 points (95% CI 2.3 to 4.3)) components.

One year post-operatively, those with back pain had significantly worse outcome scores than those without with a mean difference in the OKS of 5 points (95% CI 3.8 to 5.4), in the SF-12 physical component of 6 points (95% CI 5.4 to 7.1) and in the mental component of 4 points (95% CI 3.1 to 4.9). Patients with back pain were less likely to be satisfied (OR 0.62, 95% CI 0.5 to 0.78).

After adjusting for confounding variables, concomitant back pain was an independent predictor of a worse post-operative OKS, and of dissatisfaction. Clinicians should be aware that patients suffering concomitant back pain pre-operatively are at an increased risk of being dissatisfied post-operatively.

Cite this article: Bone Joint J 2013;95-B:1632–9.

Background. A cornerstone in treating low back pain (LBP) is the provision of information to patients, and the internet is increasingly being used as a source of health information delivery. However, the effect of and satisfaction with online information have been questioned. Purpose. To develop a multi-item instrument to measure an index score of satisfaction with online information for patients with LBP. Methods. The conceptualization of this patient reported outcome is modelled on the assumption of a formative model. The first draft of the questionnaire was developed based on a previous published interview study of 15 patients and evaluated for face validity by seven experts. The second draft of the questionnaire was pilot-tested in 20 patients to optimize content validity. Patients were recruited from a rehabilitation center and from social media. Results. An eight-item questionnaire was developed after assessing content and face validity. The items were related to design, readability, customization, credibility, usability, and coping. A labelled categorical scale was used for response options. Each item is scored from 0–3, where 0 indicates not at all satisfied, 1 indicates little satisfaction, 2 indicates some satisfaction, and 3 indicates very satisfied giving an overall index score between 0 and 24 points. Conclusion. An eight-item questionnaire measuring satisfaction with an index score from 0–24 points has been developed. The OPSI questionnaire is now being tested for construct validity, reproducibility and interpretation on 150 patients with LBP. No conflicts of interest. Sources of funding: Funded by the Novo Nordic Foundation (NNF17OC0024422)

Aims. We introduced a self-care pathway for minimally displaced distal radius fractures, which involved the patient being discharged from a Virtual Fracture Clinic (VFC) without a physical review and being provided with written instructions on how to remove their own cast or splint at home, plus advice on exercises and return to function. Methods. All patients managed via this protocol between March and October 2020 were contacted by a medical secretary at a minimum of six months post-injury. The patients were asked to complete the Patient-Rated Wrist Evaluation (PRWE), a satisfaction questionnaire, advise if they had required surgery and/or contacted any health professional, and were also asked for any recommendations on how to improve the service. A review with a hand surgeon was organized if required, and a cost analysis was also conducted. Results. Overall 71/101 patients completed the telephone consultation; no patients required surgery, and the mean and median PRWE scores were 23.9/100 (SD 24.9) and 17.0/100 (interquartile range (IQR) 0 to 40), respectively. Mean patient satisfaction with treatment was 34.3/40 (SD 9.2), and 65 patients (92%) were satisfied or highly satisfied. In total there were 16 contact calls, 12 requests for a consultant review, no formal complaints, and 15 minor adjustment suggestions to improve patient experience. A relationship was found between intra-articular injuries and lower patient satisfaction scores (p = 0.025), however no relationship was found between PRWE scores and the nature of the fracture. Also, no relationship was found between the type of immobilization and the functional outcome or patient satisfaction. Cost analysis of the self-care pathway V traditional pathway showed a cost savings of over £13,500 per year with the new self-care model compared to the traditional model. Conclusion. Our study supports a VFC self-care pathway for patients with minimally displaced distal radius fractures. The pathway provides a good level of patient satisfaction and function. To improve the service, we will make minor amendments to our patient information sheet. Cite this article: Bone Jt Open 2022;3(9):726–732

In the field of hand surgery, physicians are working to improve patient satisfaction by offering several minor procedures in the physician's office via the WALANT method. We seek to investigate the degree of patient satisfaction, out of pocket cost, convenience and comfort experienced with in-office hand procedures. A ten question survey consisting of a ten-point Likert scale of agreement and questions asking for a numerical answer was administered via phone call to 33 patients treated with minor hand operations in the office setting in the United States. There were 18 male and 15 female respondents with an average age of 65.59±12.64 years. Respondents underwent procedures including trigger finger release (18), needle aponeurotomy (7), and other minor hand operations. Survey responses indicated strong agreement with questions 1-3 and 6–8, with responses averaging 9.60±0.23 in these positive metrics. Questions 4 and 5, which asked whether the surgery and recovery period were painful, respectively, averaged 2.65±0.49, indicating a mild level of disagreement that either was “painful”. Additionally, most patients responded that they did not take time off work (12) or are not currently employed (11). Other respondents (3) reported taking between one to five days off work post-operatively. 27 respondents also reported an out of pocket cost averaging $382±$976, depending on insurance coverage. Patients reported a small degree of pain in the operative and post-operative period, a high degree of comfort and convenience and a high degree of satisfaction. Likewise, the patient-reported out of pocket cost was far lower than comparable surgical costs in alternate settings. These results support the use of in-office procedures for minor hand surgeries from a patient perspective and indicate a nearly universal intent to repeat any future hand operations in the office setting

Ten to twenty percent of patients are dissatisfied with the clinical result after total knee arthroplasty (TKA). Aim of this study was to investigate the impact of personality traits on patient satisfaction and subjective outcome of TKA. We investigated 80 patients with 86 computer navigated TKAs (Emotion®, B Braun Aesculap) and asked for patient satisfaction. We divided patients into two groups (satisfied or dissatisfied). 12 personality traits were tested by an independent psychologist, using the Freiburg Personality Inventory (FPI-R). Postoperative examination included Knee Society Score (KSS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Visual Analogue Scale (VAS). Radiologic investigation was done in all patients. 84% of our patients were satisfied, while 16% were not satisfied with clinical outcome. The FPI-R showed statistically significant influence of four personality traits on patient satisfaction: life satisfaction (ρ = 0.006), performance orientation (ρ =0.015), somatic distress (ρ = 0.001), and emotional stability (ρ = 0.002). All clinical scores (VAS, WOMAC, and KSS) showed significant better results in the satisfied patient group. Radiological examination showed optimal alignment of all TKAs. There were no complications requiring revision surgery in both groups. The results of our study show that personality traits may influence patient satisfaction and clinical outcome after TKA. Thus, patients personality traits may be a useful predictive factor for postoperative satisfaction after TKA

Aims. Young adults undergoing total hip arthroplasty (THA) largely have different indications for surgery, preoperative function, and postoperative goals compared to a standard patient group. The aim of our study was to describe young adult THA preoperative function and quality of life, and to assess postoperative satisfaction and compare this with functional outcome measures. Methods. A retrospective cohort analysis of young adults (aged < 50 years) undergoing THA between May 2018 and May 2023 in a single tertiary centre was undertaken. Median follow-up was 31 months (12 to 61). Oxford Hip Score (OHS) and focus group-designed questionnaires were distributed. Searches identified 244 cases in 225 patients. Those aged aged under 30 years represented 22.7% of the cohort. Developmental dysplasia of the hip (50; 45.5%) and Perthes’ disease (15; 13.6%) were the commonest indications for THA. Results. Preoperatively, of 110 patients, 19 (17.2%) were unable to work before THA, 57 (52%) required opioid analgesia, 51 (46.4%) were reliant upon walking aids, and 70 (63.6%) had sexual activity limited by their pathology. One patient required revision due to instability. Mean OHS was 39 (9 to 48). There was a significant difference between the OHS of cases where THA met expectation, compared with the OHS when it did not (satisfied: 86 (78.2%), OHS: 41.2 (36.1%) vs non-satisfied: 24 (21%), OHS: 31.6; p ≤ 0.001). Only one of the 83 patients (75.5%) who returned to premorbid levels of activity did so after 12 months. Conclusion. Satisfaction rates of THA in young adults is high, albeit lower than commonly quoted figures. Young adults awaiting THA have poor function with high requirements for mobility aids, analgesia, and difficulties in working and undertaking leisure activities. The OHS provided a useful insight into patient function and was predictive of satisfaction rates, although it did not address the specific demands of young adults undertaking THA. Function at one year postoperatively is a good indication of overall outcomes. Cite this article: Bone Jt Open 2024;5(4):304–311

Background. NHS improvement advocates same day emergency care (SDEC) for patients requiring additional specialism than can be provided in an Emergency Department. A novel physiotherapist-led spinal SDEC unit was established in January 2020, integrated within the on-call spinal service. The aim of this paper was to evaluate patient and peer satisfaction with the spinal SDEC. Methods. Patient satisfaction questionnaires and/or friends and family tests were collected from patients over a six-month period. Questionnaires evaluated satisfaction with recommendations given, service given, staff friendliness. Anonymous, completed questionnaires were uploaded onto a spreadsheet. Peer satisfaction was assessed using a google sheets document emailed to interface, primary care and community services. The questionnaire captured the respondents’ role, how many patients they had referred to the SDEC, reasons for referral, ease of referral, and compared this new pathway with the previous pathway. All patient's satisfaction responses recommended the service to family and friends (n=110 extremely likely, 8 likely) (6% total seen). All respondents were satisfied with the service they received (n=80 very satisfied, n=12 satisfied) and recommendations made (n=86 very satisfied, n=6 satisfied). Of peer satisfaction, 26 respondents (n=12 (46%) physiotherapists, n=6 (23%) first contact practitioners, n=6 (23%) advanced practice physiotherapists, n=1 (4%) GP, n=1 (4%) nurse) reported the SDEC delivered a better pathway and outcomes (n=25, 96%), and 20 (77%) respondents reported favourable comments of the service and its impact on patients and referrers. Conclusion. Peer and patient satisfaction data support the use of a physiotherapist-led spinal SDEC in emergency and urgent spinal care pathways. Conflicts of interest: No conflicts of Interest. Sources of interest: No sources of funding

The purpose of the this survey study was twofold: 1) to examine different aspects of satisfaction with post-operative care in injured workers who have undergone rotator cuff surgery and 2) to examine the relationship between receiving a newly implemented summary report and the overall satisfaction with surgery and recovery. The clinical communication summary report was given to injured workers following their review assessment to share with the family doctor or other health care providers. The form indicated a need for further assessments or investigations and return to work recommendations. The study involved using a satisfaction survey that examined different aspects of follow-up visit and workers’ opinion about their understanding of the nature of surgery, their progress, clinical management, and usefulness of the newly implemented summery report. Eighty patients completed the questionnaire (mean age: 54 (8), 62(78%) males, of whom 26 (34%) had a rotator cuff decompression and 31 (40%) had a rotator cuff repair with 20 (26%) having both procedures and three missing data. There were no statistically significant relationships between the patient demographics (age, sex or type of surgery) and satisfaction. However, there was a significant correlation between how patients perceived the summary report in terms of helpfulness and the overall satisfaction with surgery (FTE<0.0004, p=0.001) and the satisfaction with recovery (FTE<0.0001, p=0.001). This may indicate that improvement in worker's understanding of their treatment recommendations and restrictions is associated with higher levels of overall satisfaction in this population. Our results indicate a positive linear relationship between expressing a high satisfaction and the helpfulness of the summary report. As part of improving care, adding a summary report may facilitate sharing information with the injured workers, their care providers and their workplace

Aims. Alternative alignment concepts, including kinematic and restricted kinematic, have been introduced to help improve clinical outcomes following total knee arthroplasty (TKA). The purpose of this study was to evaluate the clinical results, along with patient satisfaction, following TKA using the concept of restricted kinematic alignment. Methods. A total of 121 consecutive TKAs performed between 11 February 2018 to 11 June 2019 with preoperative varus deformity were reviewed at minimum one-year follow-up. Three knees were excluded due to severe preoperative varus deformity greater than 15°, and a further three due to requiring revision surgery, leaving 109 patients and 115 knees to undergo primary TKA using the concept of restricted kinematic alignment with advanced technology. Patients were stratified into three groups based on the preoperative limb varus deformity: Group A with 1° to 5° varus (43 knees); Group B between 6° and 10° varus (56 knees); and Group C with varus greater than 10° (16 knees). This study group was compared with a matched cohort of 115 TKAs and 115 patients using a neutral mechanical alignment target with manual instruments performed from 24 October 2016 to 14 January 2019. Results. Mean overall patient satisfaction for the entire cohort was 4.7 (SE 0.1) on a 5-point Likert scale, with 93% being either very satisfied or satisfied compared with a Likert of 4.3 and patient satisfaction of 81% in the mechanical alignment group (p < 0.001 and p < 0.006 respectively). At mean follow-up of 17 months (11 to 27), the mean overall Likert, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, and Knee Society Knee and Function Scores were significantly better in the kinematic group than in the neutral mechanical alignment group. The most common complication in both groups was contracture requiring manipulation under anaesthesia, involving seven knees (6.1%) in the kinematic group and nine knees (7.8%) in the mechanical alignment group. Conclusion. With the advent of advanced technology, and the ability to obtain accurate bone cuts, the target limb alignment, and soft-tissue balance within millimetres, using a restricted kinematic alignment concept demonstrated excellent patient satisfaction following primary TKA. Longer-term analysis is required as to the durability of this method. Cite this article: Bone Joint J 2021;103-B(6 Supple A):59–66

Complications such as implant loosening, infection, periprosthetic fracture or instability may lead to revision arthroplasty procedures. There is limited literature comparing single-stage and two-stage revision shoulder arthroplasty. This study aims to compare clinical outcomes and cost benefit between single-stage and two-stage revision procedures. Thirty-one revision procedures (mean age 72+/-7, 15 males and 16 females) performed between 2016 and 2021 were included (27 revision RSA, 2 revision TSA, 2 failed ORIFs). Two-stage procedures were carried out 4-6 weeks apart. Single-stage procedures included debridement, implant removal and washout, followed by re-prep, re-drape and reconstruction with new instrumentations. Clinical parameters including length of stay, VAS, patient satisfaction was recorded preoperatively and at mean 12-months follow up. Cost benefit analysis were performed. Seven revisions were two-stage procedures and 24 were single-stage procedures. There were 5 infections in the two-stage group vs 14 in the single-stage group. We noted two cases of unstable RSA and 8 other causes for single-stage revision. Majority of the revisions were complex procedures requiring significant glenoid and/or humeral allografts and tendon transfers to compensate for soft tissue loss. No custom implants were used in our series. Hospital stay was reduced from 41+/-29 days for 2-stage procedures to 16+/-13 days for single-stage (p<0.05). VAS improved from 9+/-1 to 2+/-4 for two-stage procedures and from 5+/-3 to 1+/-2 for single-stages. The average total cost of hospital and patient was reduced by two-thirds. Patient satisfaction in the single-stage group was 43% which was comparable to the two-stage group. All infections were successfully treated with no recurrence of infection in our cohort of 31 patients. There was no instability postoperatively. 3 patients had postoperative neural symptoms which resolved within 6 months. Single-stage procedures for revision shoulder arthroplasty significantly decrease hospital stay, improve patients’ satisfaction, and reduced surgical costs

There are numerous patient satisfaction questionnaires by none specific for an Independent Medical Examination (IME). The aim of this study was to develop and evaluate a questionnaire suitable for an IME. The questionnaire (IMESQ) consisted of five process domains (“Interpersonal manner”, “Communication”, “Technical ability”, “Information exchange”, “Time allocation”) and an outcome domain (“Satisfaction”), each with a five-scale Likert response. An 11-point numerical satisfaction scale (NSS) and a 3-point scale question on the “willing to undergo another examination with the doctor if required” were alternative measures of validation. The questionnaire was tested against numerous independent variables. Statistical analysis included Spearman correlation ((r. S. ) between the items in the questionnaire and the total score with the NSS, and “willing to undergo another examination with the doctor if required” with point-biserial correlation (r. pb. ). Internal consistent reliability was tested using split-half correlation coefficient (r. SB. ) and Cronbach's alpha coefficient (α). The construct was subjected to Factor Analysis. The results from 53 respondents were analysed. There was moderate to strong inter-item correlation (r. s. range 0.57 to 0.83, median 0.67, p < 0.01) and good correlation with the NSS (r. s. = 0.79, p < 0.01) and dichotomous question (r. pb. = 0.45, p < 0.01). Five respondents were “neither satisfied or dissatisfied” (Item 6) and 12 recorded “maybe” to further examination. The split-half correlation was strong (r. SB. = 0.76, p < 0.01). There was good internal consistency reliability (α = 0.92). “Interpersonal manner” (ψ = 4.3) was the only item to have an eigenvalue greater than one, accounting to 72% of the variance across the scale. Eigenvector analysis confirmed the questionnaire was unidimentional. The IMESQ is a brief questionnaire to assess satisfaction with an IME. It is validated and has good internal consistency reliability. The five process domains can identify areas of suboptimal performance: useful for a 360° audit

During the COVID-19 pandemic, video/phone consultations (VPC) were increasingly utilised as an alternative to face-to-face (F2F) consultations, to minimise nosocomial viral exposure. We previously demonstrated that VPCs were highly rated by both patients and clinicians. This study compared satisfaction between both clinic modalities in contemporaneously delivered outpatient surveys. We also assessed the feasibility and effects of converting F2F orthopaedic consultations to VPC. Surveys were posted to patients who attended VPCs and F2F consultations at a large tertiary centre from August to October 2020 inclusive, across 51 specialties. F2F and VPC patients ranked their overall satisfaction with their consultation on a 10-point numerical scale (10=highest satisfaction). Simultaneously, a pilot study was undertaken of outpatient fracture clinics to identify patients suitable for VPCs, with X-rays (if needed) taken and transferred from satellite sites to reduce tertiary centre footfall. For F2F consultations, 1419 of 4465 surveys (31.8%) were returned with similar rates for VPCs (1332 of 4572, 29.1%). While mean satisfaction ratings were high for both clinic modalities, they were significantly higher for F2F: 9.13 (95% CI 9.05-9.22) for F2F clinics, compared to 8.23 (95% CI 8.11-8.35) for VPCs (p<0.001, t-test). F2F patients were almost four times more likely to state a preference for future F2F appointments compared to VPCs, whereas patients who attended VPCs showed an equal preference for either option (p< 0.001, chi2 test). 53% of 111 fracture clinic patients sampled were identified as suitable for VPCs. 1 patient (1.7%) requested their VPC to be converted to F2F due to poor symptom control. Our study showed patients reported high satisfaction ratings for both F2F clinics and VPCs, with prior experience of VPCs affecting patients’ future preferences. Only 1.7% of F2F patients converted to VPCs declined their virtual appointment. Our results support future use of VPCs

In patients admitted to hospital with a hip fracture, urinary issues are common. Despite guidelines that recommend avoiding foley catheter usage when possible, it remains a common part of perioperative care. To date, there is no prospective data on the safety and satisfaction associated with catheter use in such cohort. The aim of this study was to evaluate the satisfaction of patients when using a foley catheter while they await surgery for their fractured hip and the safety associated with catheter use. In our prospectively collected database, 587 patients were admitted to our tertiary care center over a 1 year period. Most patients (328) were catheterized within the first 24h of admission, primarily inserted in ED. Of these patients, 119 patients (61 catheterized and 58 noncatheterized) completed a questionnaire about their perioperative management with foley catheter usage administered on day 1 of admission. This was used to determine satisfaction of catheter use (if catheterized) and pain levels (associated with catheterized or associated with transferring/voiding if not catheterized). Adverse effects related with catheter use included urinary tract infection (UTI) and post-operative urinary retention (POUR). Ninety-five percent of patients found the catheter to be convenient. Only 5% of patients reported any pain with catheter use. On the contrary, 47.5% of non-catheterized patients found it difficult to move to the bathroom and 30.4% found it difficult to urinate. Catheterized patients had significative less pain than uncatheterized patients (0.62/10 vs 2.45/10 respectively, p < 0 .001). The use of nerve block reduced pain levels amongst catheterized patients but was not associated with reduced pain levels or satisfaction amongst non-catheterized patients. The use of catheter was not associated with increased risk of UTI(17.5% in the catheterized vs 13.3% in the non-catheterized, p = 0.541) or POUR (6.8% in the catheterized vs 11.1% in the non-catheterized, p = 0.406). This study illustrates the benefits and safety associated with the use of urinary catheters in the pre-operative period amongst hip fractures. The use of catheters was associated with reduced pain and satisfaction without increasing post-operative UTI or POUR. These findings suggest that pre-operative catheter use is associated with less pain and more satisfaction for patients awaiting hip surgery and whom other measures, such as nerve blocks, are unlikely to reduce the discomfort associated with the mobility required to void. A prospective randomized control study could lead to a more evidence based approach for perioperative foley catheter usage in hip fracture patients

Aims. Brachial plexus injury (BPI) is an often devastating injury that affects patients physically and emotionally. The vast majority of the published literature is based on surgeon-graded assessment of motor outcomes, but the patient experience after BPI is not well understood. Our aim was to better understand overall life satisfaction after BPI, with the goal of identifying areas that can be addressed in future delivery of care. Methods. We conducted semi-structured interviews with 15 BPI patients after initial nerve reconstruction. The interview guide was focused on the patient’s experience after BPI, beginning with the injury itself and extending beyond surgical reconstruction. Inductive and deductive thematic analysis was used according to standard qualitative methodology to better understand overall life satisfaction after BPI, contributors to life satisfaction, and opportunities for improvement. Results. Among the 15 patients interviewed, the following themes emerged: 1) happiness and life satisfaction were noted despite limitations in physical function; 2) quality of social support influences life satisfaction during recovery from BPI; and 3) social participation and having a sense of purpose impact life satisfaction during recovery from BPI. Conclusion. How patients perceive their BPI treatment and recovery varies widely, and is not directly linked to their self-reported functional outcome. Patients with stronger social circles and activities that give them a sense of fulfillment were more likely to be satisfied with their current status. Evaluating a patient’s social network, goals, and potential supportive adaptations early in the treatment timeline through coordinated multidisciplinary care may improve overall satisfaction during recovery from BPI. Cite this article: Bone Joint Open 2020;2(1):9–15

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

Overall, hip and knee total joint replacement (TJR) patients experience marked benefit, with reported satisfaction rates of greater than 80% with regard to pain relief and improved function. However, many patients experience ‘nuisance’ symptoms, an annoyance which may cause discomfort, which can negatively impact postoperative satisfaction. The purpose of this study was to evaluate the prevalence of nuisance symptoms among TJR patients and impact on overall patient satisfaction. A prospective survey study to assess type and prevalence of primary hip/knee TJR related nuisance symptoms, and impact on patient satisfaction at six-months to one-year post-TJR was conducted. The survey was administered over a one-year period at one academic arthroplasty centre. Survey questions tapped occurrence of commonly reported nuisance symptoms (e.g. localized pain, swelling, stability, incision appearance/numbness, stiffness, clicking/noise, ability to perform activities of daily living), and impact of the symptom on overall hip/knee satisfaction rated on a 10-point visual analogue scale (VAS), (0=no impact, 10=to a great extent). Overall VAS satisfaction with TJR was also assessed (0=not at all satisfied, 10=extremely satisfied). Survey responses were analysed using descriptive statistics. The sample comprised of 974 primary TJR patients, including 590 knees (61%) and 384 hips 39%) who underwent surgery over a one-year period. Among knees, the most commonly reported nuisance symptoms and associated impact to satisfaction per mean VAS scores included: difficulty kneeling (78.2%, mean VAS 4.3, ±3.3), limited ability to run or jump (71.6%, VAS 3.3, ±3.3), numbness around incision (46.3%, VAS 3.8, ±3.3), clicking/noise from the knee (44.2%, VAS 2.7, ±2.7) and stiffness (43.3%, 3.3, ±2.7) following knee arthroplasty. Overall, 88.1% of knee patients surveyed experienced at least one self-reported nuisance symptom at one-year postoperative. Mean overall VAS satisfaction with knee TJR was reported as 9/10 (±1.7). Among hip TJR patients, the most commonly reported nuisance symptoms and associated impact to satisfaction per VAS scores were: limited ability to run or jump (68.6%, VAS 3.4, ±3.4), muscular pain in the thigh (44.8%, VAS 3 ±2.7), limp when walking (37.6%, VAS 4.1, ±3.2), hip stiffness (31%, VAS 3.1, ±2.4), and new or worsening low back pain (24.3%, VAS 2.9, ±2.5). Overall, 93.7% of patients experienced at least one self-reported nuisance symptom at one-year postoperative. Mean overall VAS satisfaction following total hip arthroplasty at one year was reported as 8.9/10 (±1.7). Nuisance symptoms following primary total hip and knee arthroplasty are very common. Despite the high prevalence of such symptoms, impact of individual symptoms to overall TJR satisfaction is minimal and overall TJR patient satisfaction remains high. Careful preoperative counselling regarding the prevalence of such symptoms is prudent and will help establish realistic expectations following primary hip and knee TJR

Abstract. Abstract:. Background. The dissatisfaction rate in patients operated with TKR is generally quoted to be around 20% in various registries in patients operated by multiple surgeons. The data of satisfaction rates following a TKR performed by single high volume surgeons is lacking. Aim. To study the satisfaction rate and Net Promoter Score (NPS) of consecutively operated TKR patients by a single surgeon with a minimum 1 year follow up. Methods. 860 out of 883 patients who were operated between 1st April, 2018 and 31st March, 2019 were contacted by a telephonic call. They were asked 3 questions related to their experience about the operation. The patient satisfaction, NPS and reason for dissatisfaction were assessed. Results. The overall satisfaction rate of 95.93% and a net promoter score of +96.63 was observed. When the NPS was calculated as the worst case scenario, a score of +93.70 was observed. 6 patients were unsatisfied with causes directly related to the surgery. Conclusion. TKR can have as high satisfaction rates with very high NPS in experienced surgical hands using standard techniques. These results may form a benchmark against which newer technologies can be compared

Introduction. Patient satisfaction is an important outcome measure after total knee arthroplasty (TKA) and is the ultimate goal of surgery. However, patient satisfaction reflects a complex construct of the patient's personal expectations and preferences in addition to subjective evaluation of outcome after TKA. Multiple studies have found a patient dissatisfaction rate of approximately 20% at 1 year after TKA. The purpose of this study is to determine whether there is an association between a single-item validated TKA satisfaction score and patient-reported outcome measures (PROMs) at 3 time points (1, 2, and 5 years after TKA) and to determine if dissatisfaction rate after TKA varies over time. Methods. A multi-center, prospective cohort of 12,952 patients (8,078 patients were assessed at 1-year, 702 patients at 2-year, and 4,172 patients at 5-year) undergoing primary TKA were enrolled by 230 surgeons in 28 states between 2012–2015. Surgeons practices varied in size, reimbursement models, and geographic setting ensuring that the cohort included diverse patient populations and delivery models. Surgeons agreed to invite all TKA patients to participate and sporadic audits of surgical logs validated that all patients were invited and > 90% of patients were included. Demographic and clinical data [age, gender, body mass index (BMI), and modified Charlson co-morbidity index (CCI)] were collected. Patient-reported outcome measures (PROMs) were collected pre-op and post-op at 1, 2, and 5 years using an internet-based platform including the KOOS (total score, and pain, ADL, QoL sub scores), KOOS Jr, SF-36 (PCS and MCS). We used the single-item satisfaction scale which was tested and validated by the Swedish Knee Arthroplasty Registry. The patients' responses were made on 5-point Likert scale (very satisfied, somewhat satisfied, neutral, somewhat dissatisfied, very dissatisfied). Patients were classified into 2 categories: satisfied group for patients who answered satisfied or very satisfied and dissatisfied group for patients answered neutral, somewhat dissatisfied, or very dissatisfied. Univariate analysis of the difference between the satisfied and dissatisfied patients' groups was performed using Mann-Whitney U test for continuous variables and chi-square test for categorical variables. Logistic regression model was performed to study the correlation between the satisfaction and PROMs with 95% confidence interval. Results. Mean age was 66.6 years, 62.7% were female, and mean BMI was 31.6. The CCI was 0 in 55.1%, 1 in 22%, 2–5 in 12.6% and ≥ 6 in 10.3%. Cumulative revision rate was 1.29% at 2 years. The 30-day adverse events incidence was 2.5% while the 90-day adverse events incidence was 4.7%. The dissatisfaction rate was 18.1% at 1-year, 11.5% at 2-year, and 8.5% at 5-year (P<0.001, Chi-square). Dissatisfaction significantly affects younger patients (<55 years) (P=0.04, Chi-square) and patients with high Charlson comorbidity index >1 (P=0.001, Chi-square). Low post-operative KOOS Pain, KOOS ADL, KOOS total score, KOOS JR, SF-36 PCS, and SP-36 MCS scores were significantly associated with dissatisfaction (P<0.001). At 5 years follow-up, in patients with KOOS scores greater than 70, 1.3% of patients were dissatisfied; with KOOS 50–70, 16.3% were dissatisfied and when KOOS < 50, 62.2% are dissatisfied. Logistic regression showed significant correlation of satisfaction with postoperative KOOS pain, KOOS ADL, KOOS QoL, KOOS total score, KOOS JR, and SF-36 PCS (P< 0.001) at 1-year, 2-year, and at 5-year. The MCS was correlated with patient satisfaction only at 1-year (P< 0.001). Conclusion. The patient dissatisfaction rate 5 years after TKA is 8.1% in FORCE-TJR patients which is significantly lower than 18.1% at 1-year. Less improvement of PROM scores after TKA are significantly associated with patient dissatisfaction. Postoperative PROM scores are associated with patient satisfaction at 1-year, 2-years, and 5-years. When the 5-year post- op KOOS total score is >70, 98.7% of patients are satisfied and only 1.3% are dissatisfied. Patient satisfaction is an important outcome measure after TKA that can be determined by asking a single question. However, in order to understand why a patient is dissatisfied, KOOS scores (KOOS pain, KOOS ADL, KOOS QoL) that assess specific postoperative outcomes can assist in determining the reason for patient dissatisfaction after TKA

Aims. The aim of this study was to investigate the influence of age on the cost-effectiveness of arthroscopic rotator cuff repair. Patients and Methods. A total of 112 patients were prospectively monitored for two years after arthroscopic rotator cuff repair using the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), the Oxford Shoulder Score (OSS), and the EuroQol five-dimension questionnaire (EQ-5D). Complications and use of healthcare resources were recorded. The incremental cost-effectiveness ratio (ICER) was used to express the cost per quality-adjusted life-year (QALY). Propensity score-matching was used to compare those aged below and above 65 years of age. Satisfaction was determined using the Net Promoter Score (NPS). Linear regression was used to identify variables that influenced the outcome at two years postoperatively. Results. A total of 92 patients (82.1%) completed the follow-up. Their mean age was 59.5 years (. sd. 9.7, 41 to 78). There were significant improvements in the mean DASH (preoperative 47.6 vs one-year 15.3; p < 0.001) and OSS scores (26.5 vs 40.5; p < 0.001). Functional improvements were maintained with no significant change between one and two years postoperatively. The mean preoperative EQ-5D was 0.54 increasing to 0.81 at one year (p < 0.001) and maintained at 0.86, two years postoperatively. There was no significant difference between those aged below or above 65 years of age with regards to postoperative shoulder function or EQ-5D gains. Smoking was the only characteristic that significantly adversely influenced the EQ-5D at two years postoperatively (p = 0.005). A total of 87 were promoters and five were passive, giving a mean NPS of 95 (87/92). The total mean cost per patient was £3646.94 and the mean EQ-5D difference at one year was 0.2691, giving a mean ICER of £13 552.36/QALY. At two years, this decreased further to £5694.78/QALY. This was comparable for those aged below or above 65 years of age (£5209.91 vs £5525.67). Smokers had an ICER that was four times more expensive. Conclusion. Arthroscopic rotator cuff repair results in excellent patient satisfaction and cost-effectiveness, regardless of age. Cite this article: Bone Joint J 2019;101-B:860–866

Introduction. Mechanical axis limb alignment in total knee arthroplasty (TKA) has demonstrated excellent long-term survivorship; however, patient satisfaction continues to demand improvement. Alternative emerging alignment concepts including kinematic and tibial constitutional varus have been introduced but remain controversial. The purpose of this study was to evaluate outcomes and patient satisfaction following TKA with tibial components placed in constitutional varus alignment. Methods. This was a retrospective cohort analysis from a total joint registry of 114 patients with preoperative varus deformity who underwent primary TKA with tibial component placed in 1–3 degrees of constitutional varus. The group included 59 males (52%) and 55 (48%) females with a mean age of 67 years (range 43 – 85) and mean BMI of 32.0 kg/m. 2. (range 21 – 51 kg/m. 2. ) with a minimum 1 year follow-up. Patients were stratified into 3 groups based on the preoperative varus alignment: Group A between 1°- 5° varus (43 knees), Group B between 6°- 10° (56 knees), and Group C greater than 10° (16 knees). The target constitutional tibial varus alignment was selected based on the extent of the patient's deformity. Results. The average overall patient satisfaction was 4.7 on a 5-point Likert scale with 93% being either very satisfied or satisfied. Group A had the highest overall patient satisfaction of 95% followed by Group B (93%) and Group C (88%). Mean Forgotten Joint Score (FJS-12) for the combined groups was 86, mean KOOS Jr. score 72, mean WOMAC score 90, mean Knee Society (KS) Knee Score 93 and mean KS Function Score was 85. Conclusion. The push for more patient centered outcome measures drives the pursuit of improving patient satisfaction in addition to traditional outcome measures. Tibial components placed in constitutional varus in this study demonstrated excellent patient satisfaction and improvement in knee function following TKA

Introduction. Patient reported outcome measures (PROMs) are increasingly used as quality benchmarks in total joint arthroplasty (TJA). The objective of this study was to investigate whether PROMs correlate with patient satisfaction, which is arguably the most important and desired outcome. Methods. An institutional joint database was queried for patients who underwent primary, elective, unilateral TJA. Eligible patients were asked to complete a satisfaction survey at final follow-up. Correlation coefficients (R) were calculated to quantify the relationship between patient satisfaction and prospectively collected PROMs. We explored a wide range of PROMs including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); Short Form-12 (SF-12), Oxford Hip Score (OHS), Knee Society Clinical Rating Score (KSCRS), Single Assessment Numerical Evaluation (SANE), and University of California Los Angeles activity level rating (UCLA). Results. In general, there was only weak to moderate correlation between patient satisfaction and PROMs. Querying the absolute postoperative scores had higher correlation with patient satisfaction compared to either preoperative scores or net changes in scores. The correlation was higher with disease-specific PROMs (WOMAC, OHS, KSCRS) compared to general health (SF-12), activity level (UCLA), or perception of normalcy (SANE). Within disease-specific PROMs, the pain domain consistently carried the highest correlation with patient satisfaction (WOMAC pain subscale, R = 0.45, p <0.001; KSCRS pain subscale, R = 0.49, p <0.001). Conclusion. There is only weak to moderate correlation between PROMs and patient satisfaction. PROMs alone are not the optimal way to evaluate patient satisfaction. We recommend directly querying patients about satisfaction and using shorter PROMs, particularly disease-specific PROMs that assess pain perception to better gauge patient satisfaction. For figures, tables, or references, please contact authors directly

Introduction. W. ide . A. wake . L. ocal . A. naesthetic . N. o . T. ourniquet (WALANT) is a well- established day case procedure for carpal tunnel release with several advantages and enhanced post-operative recovery. Use of Local anaesthesia with Adrenaline using a 27G needle allows a bloodless field and distraction techniques achieve patient comfort during the procedure. Objectives. This retrospective, observational cohort study assesses patient satisfaction and undertakes functional evaluation using the validated Boston Carpal Tunnel Questionnaire (BCTQ) following WALANT technique for carpal tunnel release (CTR). The BCTQ has a symptom severity scale based on 11 items and a functional status scale of 8 elements. Further we compare surgical outcomes between techniques of WALANT and traditional CTR. Patient and Methods. We included 30 consecutive patients, 15 in each arm who either underwent traditional CTR with the use of Tourniquet or with the WALANTtechnique. Data was collected from Electronic Patient Records and hand therapy assessments. A satisfaction questionnaire and Visual Analogue Score (VAS) was utilized to evaluate subjective outcomes. Functional outcomes was assessed by BCTQ scoring system and clinical review. Microsoft Excel was used for analysis. Results. 100% of patients in the WALANT group stated they were satisfied with the operation. Relief from night pain and sleep disturbance were the most improved symptoms. BCTQ and clinical assessment evaluation between both groups revealed comparable results with no significant difference. Conclusion. With advantages of no tourniquet related pain, increased patient satisfaction and functional outcomes on the BCTQ scores, WALANT technique has the potential to be the standard technique for CTR

Patient satisfaction is an important measure of patient-centered outcomes and physician performance. Given the continued growth of the population undergoing surgical intervention for osteoarthritis (OA), and the concomitant growth in the associated direct costs, understanding what factors drive satisfaction in this population is critical. A potentially important driver not previously considered is satisfaction with pre-surgical consultation. We investigated the influence of pre-surgical consultation satisfaction on overall satisfaction following surgery for OA. Study data are from 1263 patients who underwent surgery for hip (n=480), knee (n=597), and spine (n=186) OA at a large teaching hospital in Toronto, Canada. Before surgery, patient-reported satisfaction with information received and degree of input in decision-making during the pre-surgical consultation was assessed, along with expectations of surgery (regarding pain, activity limitation, expected time to full recovery and likelihood of complete success). Pre- and post-surgery (6 weeks, and 3, 6, and 12 months) patients reported their average pain level in the past week (0–10, 10 is worst). At each follow-up time-point, two pain variables were defined, pain improvement (minimal clinically important difference from baseline ≥2 points) and ‘acceptable’ pain (pain score ≤ 3). Patients also completed a question on satisfaction with the results of the surgery (very dissatisfied/dissatisfied/somewhat satisfied/very satisfied) at each follow-up time point. We used multilevel ordinal logistic regression to examine the influence of pre-surgery satisfaction with consultation on the trajectory of satisfaction over the year of recovery controlling for expectations of surgery, pain improvement, acceptable pain, socio-demographic factors (age, sex, and education), body mass index, comorbidity, and depressive symptoms (Hospital Anxiety and Depression Scale). Mean age of the sample was 65.5 years, and over half (54.3%) were women. Overall, 74% and 78.9% of patients were satisfied with the information received and with the decision-making in the pre-surgical consultation, respectively, no significant differences were found by surgical joint (p=0.22). Post-surgery, levels of satisfaction varied very little over time (6 weeks: 92.5% were satisfied and 66.4% were very satisfied, 1 year: 91.1% were satisfied and 65.6% were very satisfied). Results from a model including time, surgical joint, satisfaction with consultation and control factors indicated that being satisfied with the information received in the pre-surgical consultation was associated with higher odds of being more satisfied after surgery (OR: 1.2, 95% CI: 1–1.4). Additionally, spine and knee patients were more likely to be dissatisfied than hip patients (OR: 3.2, 95% CI: 2.1–4.9 and OR: 2.5, 95% CI: 1.8–3.4 for spine and knee patients respectively). Achieving pain improvement (OR: 1.7, 95% CI: 1.3–2.4) and acceptable pain (OR: 2.5, 95% CI: 1.6–3.9) were both significantly associated with greater satisfaction. Pre-operative expectations were not significantly associated with post-surgery satisfaction. Findings highlight the important role of pre-surgery physician-patient communication and information on post-surgery satisfaction. This points to the need to ensure organizational provisions that foster supportive and interactive relationships between surgeons and their patients to improve patients' satisfaction. Findings also highlight that early post-recovery period (i.e. <= 3 months) as a key driver of longer-term satisfaction

Up to 20 percent of patients remain dissatisfied after primary total knee arthroplasty (TKA) surgery. Understanding the reasons for dissatisfaction post TKA may allow for better patient selection and optimized treatment for those who remain dissatisfied. The association between function, mobility and satisfaction are not well understood. The purpose of this study was to investigate the association between post-TKA satisfaction and i) pre-operative, ii) post-operative, and iii) change in knee joint function during gait. Thirty-one patients scheduled to receive primary TKA for knee osteoarthritis (OA) diagnosis were recruited and visited the Dynamics of Human Motion laboratory for instrumented walking gait analysis (using a synchronized NDI Optotrak motion capture system and AMTI force platforms in the walkway) at two time points, first within the week prior to their surgery, and second at approximately one year after surgery. At their post-operative visit, patients were asked to indicate their satisfaction with their knee prosthesis on a scale from zero to 100, with zero being totally unsatisfied and 100 being completely satisfied. Knee joint mechanics during gait at both time points were characterized by discriminant scores, the projection of their three-dimensional knee angles and moments during gait onto an existing discriminant model that was created to optimize separation of severe knee OA and healthy asymptomatic gait patterns. This discriminant model was created using data from 73 healthy participants and 73 with severe knee OA, and includes the magnitude and pattern features (captured with principal component analysis) of the knee adduction and flexion moment, and the magnitude of the knee flexion angle during gait. Larger discriminant scores indicate improved function toward healthy patterns, and smaller scores indicate more severe function. Associations between post-operative satisfaction and pre, post and change in discriminant scores were examined using Pearson correlation analyses. We also examined associations between satisfaction and pre-operative BMI, EQ5D and Oxford 12 scores, as well as changes in these scores from pre to post-TKA. Discriminant scores representing knee joint function during gait significantly improved on average after surgery (P =0.05). While overall knee joint function improved after primary TKA surgery, the amount of improvement in function was not reflected in post-operative patient satisfaction. However, the pre-operative function of the patient was negatively associated with satisfaction, indicating that patients with higher pre-operative function are overall less satisfied with their TKA surgery, regardless of any functional improvement due to the surgery. Interestingly, the only significant association with post-operative satisfaction was knee joint function, and the relationship between function and patient satisfaction following TKA appears to relate only to the baseline functional state of the patient, and not with functional improvement. This suggests that dissatisfaction post-surgery is more likely reflecting the unmet expectations of a higher functioning patient, and has implications for the need for improved understanding of pre-operative patient functional variability in TKA triage and expectation management

Introduction. Circular frames for ankle fusion are usually reserved for complex clinical scenarios. Current literature is heterogenous and difficult to interpret. We aimed to study the indications and outcomes of this procedure in detail. Materials & Methods. A retrospective cohort study was performed based on a prospective database of frame surgeries performed in a tertiary institution. Inclusion criteria were patients undergoing complex ankle fusion with circular frames between 2005 and 2020, with a minimum 12-month follow up. Data were collected on patient demographics, surgical indications, comorbidities, surgical procedures, external fixator time (EFT), length of stay (LOS), radiological and clinical outcomes, and adverse events. Factors influencing radiological and clinical outcomes were analysed. Results. 47 patients were included, with a mean follow-up of three years. The mean age at time of surgery was 63.6 years. Patients had a median of two previous surgeries. The median LOS was 8.5 days, and median EFT was 237 days. Where simultaneous limb lengthening was performed, the average lengthening was 2.9cm, increasing the EFT by an average of 4 months. Primary and final union rates were 91.5% and 95.7% respectively. At last follow-up, ASAMI bone scores were excellent or good in 87.2%. ASAMI functional scores were good in 79.1%. Patient satisfaction was 83.7%. 97.7% of patients experienced adverse events, most commonly pin-site related, with major complications in 30.2% and re-operations in 60.5%. There were 3 amputations. Adverse events were associated with increased age, poor soft tissue condition, severe deformities, subtalar fusions, peripheral neuropathy, peripheral vascular disease, and prolonged EFT. Conclusions. Complex ankle fusion using circular frames can achieve good outcomes in complicated clinical scenarios, however patients can expect a prolonged time in the frame and high rates of adverse events. Multiple risk factors were identified for poorer outcomes, which should be considered in patient counselling and prognostication

Background. The posterior slope of the tibial component in total knee arthroplasty (TKA) has been reported to vary widely even with computer assisted surgery. In the present study, we analyzed the influence of posterior tibial slope on one-year postoperative clinical outcome after posterior-stabilized (PS) -TKA to find out the optimal posterior slope of tibial component. Materials and Method. Seventy-three patients with varus type osteoarthritic (OA) knees underwent PS-TKA (Persona PS. R. ) were involved in this study. The mean age was 76.6 years old and preoperative HKA angle was 14.3 degrees in varus. Tibial bone cut was performed using standard extra-medullary guide with 7 degrees of posterior slope. The tibial slopes were radiographically measured by post-operative lateral radiograph with posterior inclination in plus value. The angle between the perpendicular line of the proximal fibular shaft axis and the line drawn along the superior margin of the proximal tibia represented the tibial slope angle. We assessed one-year postoperative clinical outcomes including active range of motion (ROM), patient satisfaction and symptoms scores using 2011 Knee Society Score (2011 KSS). The influences of posterior tibial slope on one-year postoperative parameters were analyzed using simple linear regression analysis (p<0.05). Results. The average posterior tibial slope was 6.4 ± 2.0 °. The average active ROM were −2.4 ± 6.6 ° in extension and 113.5± 12.6 ° in flexion. The mean one-year postoperative patient satisfaction and symptom scores were 29.3 ± 6.4 and 19.6 ± 3.9 points respectively. The active knee extension, satisfaction and symptom scores were significantly negatively correlated to the posterior tibial slope (r = −0.25, −0.31, −0.23). Discussion. In the present study, we have found significant influence of the posterior tibial slope on the one-year postoperative clinical outcomes in PS-TKA. The higher posterior slope would induce flexion contracture and deteriorate patient satisfaction and symptom. We had reported that the higher tibial posterior slope increased flexion gap and the component gap change during knee flexion in PS-TKA. Furthermore, another study reported that increase of the posterior tibia slope reduced the tension in the collateral ligaments and resulted in the knee laxity at flexion. The excessive posterior slope of tibial component would result in flexion instability, and adversely affected the clinical results including patient satisfaction and symptom. Conclusion. In the PS-TKA for varus type OA knees, excessive tibial posterior slope was found to adversely affect one-year postoperative knee extension and clinical outcome including patient satisfaction and symptom. Surgeons should aware of the importance of tibial slope on one-year postoperative clinical results and pay more attentions to the posterior tibial slope angle not to be excessive

Despite the widespread success of total hip arthroplasty (THA), postoperative pain management remains a concern. Opioids have classically been administered for pain relief after THA, but their side effect profile, in addition to the cognizance of the growing opioid epidemic, has incited a shift toward alternative pain modalities. Although the nonsteroidal anti-inflammatory drug (NSAID) diclofenac is a promising addition, its impact on immediate THA outcomes has not previously been investigated. Thus, in the present study, we evaluate the effects of adjunctive diclofenac on: 1) postoperative pain intensity, 2) opioid consumption, 3) discharge destination, 4) length of stay, and 5) patient satisfaction in primary THA patients. A retrospective review was performed to identify all patients who underwent primary THA by a single surgeon between May 1 and September 31, 2017. Patients were stratified into a study group (n=25), who were treated with postoperative diclofenac in addition to the standard pain control regimen, and a control group (n=88), who did not receive adjunctive diclofenac. Repeated-measures analysis of variance (ANOVA)/analysis of covariance (ANCOVA) and chi-square/logistic regression analysis were used for continuous and categorical variables, respectively. Patients receiving adjunctive diclofenac were more likely to be discharged home than to inpatient facilities (O.R. 4.02, p=0.049). In addition, patient satisfaction with respect to how well and how often pain was controlled (p= 0.0436 and p=0.0217, respectively) was significantly greater in the diclofenac group. Finally, patients who received diclofenac had lower opioid consumption on postoperative days one and two (−67.2 and −129 mg, respectively, p=0.001 for both). The rapid growth of THA as an outpatient procedure has intensified the urgency of improving postoperative pain management. The present study demonstrates that THA patients receiving adjunctive diclofenac were more likely to be discharged home, had reduced opioid consumption, and experienced greater satisfaction. This will, in turn, decrease complications and total hospital costs, leading to a more cost-effective pain control regimen. In order to further investigate the optimal regimen, future studies comprising larger cohort, as well as a comparison of diclofenac to other NSAIDs, are warranted

Background. The literature quotes up to 20% dissatisfaction rates for total knee replacements (TKR). Swedish registry and national joint registry of England and Wales confirm this with high volumes of patients included. This dissatisfaction rate is used as a basis for improving/changing/modernising knee implant designs by major companies across the world. Aim. We aimed to compare post TKR satisfaction rates for navigated and non navigated knees. Methods. This was a retrospective analysis of prospectively collected data. All patients undergo comprehensive preoperative evaluation and comprehensive consent process and same rehabilitation protocols are followed as standard practice. Two groups were established depending on whether surgery was performed with or without computer navigation. We included 229 patients in each group. There were nine bilateral cases in the navigated group giving a total of 238 knees. Both groups were similar at the time of surgery (navigated: 68 years (sd9);; BMI 32.46;; (sd5.19);; OKS: 42.2 (sd7.5);; non-navigated: 70 years (sd9);; BMI 32.36;; (sd5.26);; OKS: 42.4 (sd7.3)). The satisfaction rates are recorded as very satisfied, satisfied, unsure or dissatisfied. Results. Of the 238 navigated knees 227 (95.4%) were very satisfied or satisfied;; while of the 229 non-navigated knees 205 (89.5%) were very satisfied or satisfied. Only 3 (1.3%) navigated knees and 9 (3.9%) non-navigated knees were dissatisfied. Seven (2.9%) navigated knees and fifteen (6.6%) non-navigated knees were unsure. The navigated group showed better satisfaction (p=0.049) compared to the non-navigated group and better satisfaction than previously published satisfaction rates [3]. When combining dissatisfaction and unsure responses the navigated group again performed significantly better than the non-navigated group (p=0.021). Satisfaction rates were also compared with published literature, which suggest that 82–89% of TKA patients are satisfied and that navigation has no effect on satisfaction [3]. Our data for the non-navigated knees are similar to high end of the published data. This goes to show that comprehensive education of patients, high volume surgeons and elective arthroplasty unit along with comprehensive consent process can achieve best results. We have also shown that navigation influences satisfaction rates. There were no differences in 6 week OKS data with scores of 28.1 (sd= 8.0) and 28.8 (sd=7.8) for navigated and non-navigated groups(p=0.623), The same was also true for range of flexion/extension (92.1° [sd=13.4°& 91.3° [sd=14.1°, p=0.360) and length of hospital stay in days (median=5 [min=2, max=37], median=5 [min=2, max=19], p=0.959);; for navigated and non-navigated groups respectively. Of those navigated knees reported as ‘dissatisfied’ and ‘unsure’, 50.0% (5 knees) were due to pain in the knee. For non-navigated knees, 66.7% (16 knees) stated knee pain as the reason for being ‘dissatisfied’ or ‘unsure’. Conclusion. A modern elective arthroplasty service can deliver high satisfaction rates. Use of computer navigation further improves even the best conventional satisfaction rates. Industry should promote better surgical techniques rather than bringing out new implants to improve satisfaction rates in total knee replacements

Introduction. Patients-reported outcome measures (PROMs) have been reported as the important methods to evaluate clinical outcomes in total knee arthroplasty (TKA). The patient satisfaction score in Knee Society Score (KSS-2011) has been used in the recent literatures. Patient satisfaction was subjective parameter, and would be affected by multiple factors including psychological factors and physical conditions at not only affected joint but also elsewhere in the body. The question was raised regarding the consistency of patient satisfaction score in KSS-2011 to other PROMs. The purpose of this study was to investigate the correlation of patient satisfaction in KSS-2011 to other categories in KSS-2011 and to other PROMs including Forgotten Joint Score (FJS-12), EuroQol-5 Dimensions (EQ-5D) and 25-questions in Geriatric Locomotive Function Scale (GLFS-25). Material & Method. 83 patients over 65 years old with osteoarthritic knees were involved in this study. All patients underwent CR-TKAs (Persona CR. R. ). The means and ranges of demographics were as follows: age; 74.5 years old (65–89), Hip-Knee-Ankle (HKA) angle; 12.4 (−6.2–22.5) in varus. We asked patients to fulfill the questionnaire including KSS-2011, FJS-12, EQ-5D and GLFS-25 at 1-year postoperative follow-up visit. KSS-2011 consisted of 4 categories of questions; patient satisfaction (PS), symptoms, patient expectations (PE), functional activities (FA). We evaluated the correlation of PS to other PROMs using simple linear regression analyses (p<0.001). Results. The means and standard deviations of 1-year postoperative scores were as follows: PS; 28.5 ± 7.0, symptoms; 19.1 ± 4.3, PE; 11.2 ± 2.9, FA; 71.5 ± 16.6, FJS-12; 51.5 ± 18.6, EQ5D; 0.69 ± 0.10, GLFS-25; 25.7 ± 16.9. PSs were moderately positively correlated to other categories in KSS-2011(correlation coefficient (r): symptoms; 0.69, PE; 0.73, FA; 0.69). PSs were positively correlated to both FJS-12 and EQ5D (r: FJS-12; 0.72, EQ-5D; 0.67) and negatively correlated to GLFS-25(r; −0.74). Discussions. Patient satisfaction score positively correlated to the symptoms, patient expectation and functional activities in KSS-2011 with moderately high correlation coefficient. This meant the better pain relief and functional outcome improved patient satisfaction. Although there had be reported preoperative higher expectation would lead to poor patient satisfaction postoperatively, we interestingly found positive correlation between patient satisfaction and expectation at 1 year after TKA. Patient with the higher satisfaction tended to expect more in the future, on the other hand, unsatisfied patient with residual pain and/or poor function would resign themselves to the present status and reduced their expectation in our patient population. We have found patient satisfaction score in KSS-2011 significantly correlated to FJS-12 and GLFS-25 with strong correlation coefficient. This meant patient satisfaction could be considered consist to other PROMS in relatively younger patient with better functional status in this study. Conclusion. The patient satisfaction score in KSS-2011 was found to be consistent with moderately high correlations coefficient to other categories in KSS-2011 and other PROMs including FJS-12, EQ-5D, GLFS-25 at 1 year after (CR)-TKA. For any figures or tables, please contact authors directly

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. METHODS. One hundred and thirty five patients received TKA utilizing intra-operative sensing technology to evaluate soft-tissue balance as part of a prospective multicenter study. Patients were classified by two groups: “balanced” and “unbalanced”. Quantitative “balance” was defined as a mediolateral intercompartmental loading difference of ≤ 15 pounds; all loading exceeding 15 pounds was classified as “unbalanced”. At the one-year follow-up visit, a 7-question patient satisfaction survey was administered. The answering schema of this survey was modeled using a modified five-point Likert scale, ranging from “True” to “False” (or “Very Satisfied” to “Very Dissatisfied,” where appropriate). A meta-analysis of literature was performed and studies selected for inclusion in this analysis were required to meet the following criteria: all patients were in receipt of a primary TKA; satisfaction data was collected post-operatively; and the proportion of patients who were “satisfied” to “very satisfied” was statistically described. RESULTS. The overall satisfaction of sensor-assisted patients—indicating “satisfied” to “very satisfied”—at one-year, was 94.2%. The satisfaction levels, stratified by “balanced” and “unbalanced” patients, was 96.7% and 82.1%, respectively. The difference between the satisfaction of balanced and unbalanced patients is statistically significant (P=0.043). Twelve studies were included in the meta-analysis, which yielded a significant amount of homogeneity (B-F=3.048; homogeneity<0.001; df=11) [Figure 1]. The average satisfaction reported in literature for TKA patients is 81%, which is 16% lower than the balanced patients in the prospective patient group (P<0.001). It was found that, on average, 81% of TKA patients, as reported in the included meta-analysis literature, were “satisfied” to “very satisfied”. This represents a 16% decrease from the balanced cohort evaluated in this study (P=0.001). The average satisfaction reported in literature was more in agreement with the unbalanced cohort (82.1%). DISCUSSION. Quantifiably balanced TKA patients, verified by intraoperative sensors, exhibited significantly higher satisfaction than unbalanced patients at 1- year post-operatively (P<0.001). Specifically, the number of satisfied, balanced patients was 14.6% higher than satisfied unbalanced patients. The meta-analysis provided the opportunity to reasonably compare the average satisfaction across all included literature. The highest reported satisfaction among the evaluated literature was 90.3%, which is still 6.4% lower than the balanced patient group (P=0.045). The results of this study suggest that there may be a way to improve patient satisfaction in TKA. By verifiably balancing soft-tissues of the sensor-assisted TKA group, marked improvement in satisfaction scores was seen at one year. These trends toward better function and higher satisfaction are promising for the future of clinical success in TKA. Longer follow-up is ongoing and will be used to determine the longevity of this encouraging trend

Introduction. The relationship between sagittal component alignment on clinical outcomes has not fully evaluated after TKA. This study evaluated the effect of sagittal alignment of the components on patient function and satisfaction as well as kinematics and kinetics. Methods. This study included 148 primary TKAs with cruciate-substituting prosthesis for primary OA. With post-operative lateral radiograph, femoral component flexion angle (γ) and tibial component posterior slope angle (90-σ) was measured. The patients was classified into multiple groups by every three degrees. Patient satisfaction in 2011KSS among groups were analyzed using one-way analysis of variance. By representing the component position which showed poor clinical outcomes, computer simulation analysis was performed, in which kinematics and kinetics in squatting activity were investigated. Results. The femoral component flexion angle was 4.3 ± 3.3°, and tibial component posterior slope angle was 4.5 ± 3.4°, in average. Patients whose femoral component was implanted more than 9 degrees flexion showed lower satisfaction (Figure). There was no difference in satisfaction according to tibial component angle. Computer simulation analysis showed that excessive flexed position caused no remarkable abnormal kinematics, but increased maximum contact force in medial compartment (1097 N to 1711 N), and femoral component down-size did not fully decrease the contact force (1330 N). Similarly, increase of the maximum ligament force in medial collateral ligament (MCL) (188 N to 671 N) was observed in excessive flexed position, and femoral component downsize (343 N) did not fully recovered the ligament force. Conclusion. Excessive flexion of the femoral component showed poor satisfaction. In computer simulation, increase of the contact force of the medial compartment and MCL was observed in computer simulation. For figures, tables, or references, please contact authors directly

Background. In recent literatures, medial instability after TKA was reported to deteriorate early postoperative pain relief and have negative effects on functional outcome. Furthermore, lateral laxity of the knee is physiological, necessary for medial pivot knee kinematics, and important for postoperative knee flexion angle after cruciate-retaining total knee arthroplasty (CR-TKA). However, the influences of knee stability and laxity on postoperative patient satisfaction after CR-TKA are not clearly described. We hypothesized that postoperative knee stability and ligament balance affected patient satisfaction after CR-TKA. In this study, we investigated the effect of early postoperative ligament balance at extension on one-year postoperative patient satisfaction and ambulatory function in CR-TKAs. Materials & Methods. Sixty patients with varus osteoarthritis (OA) of the knee underwent CR-TKAs were included in this study. The mean age was 73.6 years old. Preoperative average varus deformity (HKA angle) was 12.5 degrees with long leg standing radiographs. The knee stability and laxity at extension were assessed by stress radiographies; varus-valgus stress X-ray at one-month after operation. We measured joint separation distance (mm) at medial compartment with valgus stress as medial joint opening (MJO), and distance at lateral compartment with varus stress as lateral joint opening (LJO) at knee extension position. To analyze ligament balance; relative lateral laxity comparing to the medial, varus angle was calculated. New Knee Society Score (NKSS) was used to evaluate the patient satisfaction at one-year after TKA. We measured basic ambulatory functions using 3m timed up and go test (TUG) at one-year after surgery. The influences of stability and laxity parameters (MJO, LJO and varus angle at extension) on one-year patient satisfaction and ambulatory function (TUG) was analyzed using single linear regression analysis (p<0.01). Results. MJOs at knee extension one-month after TKA negatively correlated to patient satisfaction (r=−0.37, p<0.01) and positively correlated to TUG time (r=0.38, p<0.01). LJOs at knee extension had no statistically significant correlations to patient satisfaction and TUG. The extension varus angle had significant positive correlation with patient satisfaction (r=0.40, p<0.01). Discussions. In our study, we have found significant correlations of the early postoperative MJOs at extension to postoperative patient satisfaction and TUG one-year after CR-TKA. Our results suggested that early postoperative medial knee stabilities at extension were important for one-year postoperative patient satisfaction and ambulatory function in CR-TKA. Other interest finding was that postoperative patient satisfaction was positively correlated with extension varus angle. This finding suggested that varus ligament balance; relative lateral laxity to medial stability, was beneficial for postoperative patient satisfaction after CR-TKA. Intra-operative soft tissue balance had been reported to significantly affect postoperative knee stabilities. Therefore, with our findings, surgeons might be better to manage intra-operative soft tissue balance to preserve medial stability at extension with permitting lateral laxity, which would enhance patient satisfaction and ambulatory function after CR-TKA for varus type OA knee. Conclusion. Early postoperative medial knee stability and relative lateral laxity would be beneficial for patient satisfaction and function after CR-TKA

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. To evaluate the patient's satisfaction in terms of postoperative pain and functional outcome. 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

Introduction. Total Knee Arthroplasty (TKA) is a proven successful and cost-effective method to relieve pain and improve joint function and quality of life in patients with advanced knee arthritis. However, after a TKA, only 75 to 89% of patients are satisfied. Since patient satisfaction is one of the main objectives of elective orthopaedic surgery, it is important to investigate the reasons for dissatisfaction and develop remedial strategies. Objectives. The aims of the current project are to investigate patient satisfaction after TKA and establish physical, mental and social determinants of patient satisfaction and overall socio-economic costs associated with unsatisfactory outcome. The global objective is to identify patients most likely to benefit from primary TKA, establish optimal evidence-based indications and timing for TKA, and address the necessity to educate patients preoperatively towards realistic expectations or propose alternative therapies. Based on the results, a composite score for patient selection will be developed using objective and subjective parameters. Cut-off values for acceptable indications for TKA will be proposed. Methods. General determinants of patient satisfaction are first investigated in a retrospective and prospective survey of TKA. Expectations regarding the global benefit of TKA, postoperative pain and difficulties are evaluated. Psychological tests assessing the ability of patients to cope with pain are performed. Objective clinical and radiographic parameters, patient reported outcomes and satisfaction are compared between subgroups based on (1) patient intrinsic factors such as gender and age, BMI, co-morbidities, general physical and mental health, activity, level of education and socio-economic situation, (2) implant factors, (3) surgery and surgical experience related factors. Subsequently, a randomized controlled trial of 330 consecutive primary TKAs using 3 contemporary implants of different design concepts will be carried out. Evaluation will be double-blinded (immediately preoperative randomisation, patient blinded, postoperative observer blinded). In addition, a surgeon's assessment of subjective technical difficulty will be performed. A university/teaching hospital setting will be compared with a private hospital and the influence of the surgeon on the level of patient satisfaction will be assessed. Results. Intermediate evaluation of the study revealed extensive logistic difficulties in setting up such a large scale trial and in motivating patients, nursing and medical staff to participate and sustain the necessary commitment and discipline to collect all necessary data at all follow-up intervals. Patients often felt overwhelmed by a multitude of clinical scores and technical assessments leading to a decrease in study compliance and rapid loss to follow-up. Motivation proved easier in a smaller private hospital environment. At the university hospital, patient involvement was enhanced by a personalized approach with information sessions in small groups. The introduction of a new software system with direct patient input via touch screens or remote online completion of scores reduced the data input burden. Scores are examined for simultaneous digital answering of overlapping questions. Conclusions. A large scale trial to investigate longer term patient satisfaction after TKA and establish its determinants involves continuous motivation and sustained discipline of patients and staff. A personalized approach and digital patient reported outcomes prove to maximize data acquisition

Aims. The primary aim of this study was to compare the hip-specific functional outcome of robotic assisted total hip arthroplasty (rTHA) with manual total hip arthroplasty (mTHA) in patients with osteoarthritis (OA). Secondary aims were to compare general health improvement, patient satisfaction, and radiological component position and restoration of leg length between rTHA and mTHA. Methods. A total of 40 patients undergoing rTHA were propensity score matched to 80 patients undergoing mTHA for OA. Patients were matched for age, sex, and preoperative function. The Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and EuroQol five-dimension questionnaire (EQ-5D) were collected pre- and postoperatively (mean 10 months (SD 2.2) in rTHA group and 12 months (SD 0.3) in mTHA group). In addition, patient satisfaction was collected postoperatively. Component accuracy was assessed using Lewinnek and Callanan safe zones, and restoration of leg length were assessed radiologically. Results. There were no significant differences in the preoperative demographics (p ≥ 0.781) or function (p ≥ 0.383) between the groups. The postoperative OHS (difference 2.5, 95% confidence interval (CI) 0.1 to 4.8; p = 0.038) and FJS (difference 21.1, 95% CI 10.7 to 31.5; p < 0.001) were significantly greater in the rTHA group when compared with the mTHA group. However, only the FJS was clinically significantly greater. There was no difference in the postoperative EQ-5D (difference 0.017, 95% CI -0.042 to 0.077; p = 0.562) between the two groups. No patients were dissatisfied in the rTHA group whereas six were dissatisfied in the mTHA group, but this was not significant (p = 0.176). rTHA was associated with an overall greater rate of component positioning in a safe zone (p ≤ 0.003) and restoration of leg length (p < 0.001). Conclusion. Patients undergoing rTHA had a greater hip-specific functional outcome when compared to mTHA, which may be related to improved component positioning and restoration of leg length. However, there was no difference in their postoperative generic health or rate of satisfaction. Cite this article: Bone Joint Res 2021;10(1):22–30

Background. Unicompartmental knee arthroplasty (UKA) patients with knee partial thickness cartilage loss have inferior functional performance compared to those with full thickness loss. Therefore, the aim of the present study was to investigate on the association between postoperative patients' joint awareness and satisfaction and preoperative radiographic osteoarthritis (OA) Ahlbäck grade in subjects undergoing robotic arm-assisted UKA. Methods. This retrospective observational study includes 675 patients (681 knees) undergoing robotic arm-assisted UKA at two centres between January 2014 and May 2019. Pre-operatively, knee radiographs were performed, and Ahlbäck OA grade was measured by two independent observers. Post-operatively, patients were administered the Forgotten-Joint-Score-12 (FJS-12) and 5-Level-Likert-Scale to assess joint awareness and satisfaction. Postoperative complications and revisions were recorded. Correlations were described between FJS-12, satisfaction and OA grade by means of an adjusted multivariate statistical analysis. Results. A total of 574 patients (580 UKAs) were assessed at a mean follow-up of 3.6 years post-operatively (85.2% follow-up rate; min. 12, max. 75 months). Nine UKAs were revised. Primary or secondary medial knee OA was the preoperative diagnosis in 538 cases, osteonecrosis was present in 42 cases. Cases were divided based on their preoperative Ahlbäck grade in Group A (joint space narrowing, Ahlbäck 1, 279 cases), Group B (joint space obliteration or minor bone attrition, Ahlbäck 2 and 3, 197 cases) and Group C (moderate or severe bone attrition, Ahlbäck 4 and 5, 104 cases). Moderate to severe OA grades (Group B and C) were associated with higher probability of higher postoperative FJS-12 compared to joint space narrowing group (Odds Ratio 1.6 and 1.7, respectively, p<0.05). No associations were described between OA grade and patients' satisfaction. Conclusions. Patients with preoperative joint space obliteration and minor to severe bone attrition have higher probability of a having a forgotten joint after robotic arm-assisted UKA, compared to those without full cartilage thickness loss

Background. In this study, we assessed implant survivorship, patient satisfaction, and patient-reported functional outcomes at two years for patients implanted with a customized, posterior stabilized knee replacement system. Methods. Ninety-three patients (100 knees) with the customized PS TKR were enrolled at two centers. Patients’ length of hospitalization and preoperative pain intensity were assessed. At a single time point follow-up, we assessed patient reported outcomes utilizing the KOOS Jr., satisfaction rates, implant survivorship, patients’ perception of their knee and their overall preference between the two knees, if they had their contralateral knee replaced with an off-the-shelf (OTS) implant. Results. At an average of 1.9-years implant survivorship was found to be 100%. From pre-op until time of follow-up, we observed an average decrease of 5.4 on the numeric pain rating scale. Satisfaction rate was found to be high with 90% of patients being satisfied or very satisfied and 88% of patients reporting a “natural” perception of their knee some or all the time. Patients with bilateral implants mostly (12/15) stated that they preferred their customized implant over the standard TKR. The evaluation of KOOS Jr. showed an average score of 90 at the time of the follow up. Conclusion. Based on our results, we believe that the customized PS implant provides patients with excellent outcomes post-surgery. Moreover, a subset of patients with an OTS implant in one knee and a customized PS implant in the other, we observed a trend in patients preferring the customized PS device over their OTS counterparts

Total knee arthroplasty (TKA) patients are consistently reported to be less satisfied than total hip arthroplasty (THA) patients. A patient's perception of success of his/her own total knee is dictated by their levels of post-operative pain and function, and many return to follow-up visits with inexplicable pain and stiffness that contradict favorable radiographic results. Several of these chief complaints that contribute to dissatisfaction are associated with soft-tissue imbalance. Therefore, in an effort to thoroughly understand the post-operative impact of soft-tissue balance on satisfaction, a multicenter study was conducted to evaluate the satisfaction outcomes of quantifiably balanced patients. In this study, 102 sensor-assisted patients were followed out to 3 years. The intraoperative devices used in this study project kinetic loading (lbf.) and center of load location data, in real-time, to a screen. Because of the wireless nature of the intraoperative sensors, the patella can be reduced, and kinematic data can be evaluated through the range of motion. The target balance window that was used in this study has been previously reported in literature and includes: 1) a mediolateral differential of 15 lbf., through the ROM, and 2) Sagittal plane stability as determined by a posterior drawer analysis. A robust, face-validated satisfaction survey was administered at 3-year follow-up and included 7 questions with answers on a 5-point Likert scale. At 3 years, post-operatively, 97.2% of this patient group reported being “satisfied” to “very satisfied” with their procedure, in comparison to the 81% average TKA satisfaction reported in literature (df = 11). The comparative literature included annual satisfaction intervals from 1 to 5 years (n = 33,775) which is comparable to the interval reported in this patient group. The sensor-assisted patient group exhibited a 16% increase in the proportion of satisfaction over what is currently reported in the comparative literature (p = 0.001). Despite the success rate of TKA, unfavorable patient-reported satisfaction continues to present a problem for operative recipients and surgeons. Because satisfaction is dependent upon several variables – including pain, function, and activity levels – the satisfaction survey used in this study represents a more accurate account of patient perception than many traditional surveys. It was shown that sensor-balanced TKA patients exhibited a 16% increase in the proportion of those reporting being “satisfied” to “very satisfied”, over the average satisfaction reported in literature. Allowing the surgeon to quantitatively balance the soft-tissue envelope, dynamically, has continued to a significant decrease in the proportion of dissatisfaction

Introduction: Patient satisfaction with the outcome of elective surgery is increasingly used as a measure of the patient’s perception of the success of an operation. Satisfaction is an individualistic complex of factors and measuring satisfaction can add another valuable dimension to outcomes assessment after arthroplasty. The aim of this study was to explore patient satisfaction after lower limb arthroplasty. Patients and Methods: All patients who had a primary joint replacement at the Avon Orthopaedic Centre over a 3-year period were invited to participate in the study. Participants completed a questionnaire which consisted of the WOMAC, the Joint-Related Quality of Life Scale from the KOOS/HOOS, SF-12 and a validated satisfaction scale. The satisfaction questionnaire measures patient satisfaction with four domains of outcome: overall outcome, pain relief, ability to perform ADLs and ability to participate in leisure activites. Responses are on a 4-point Likert scale which ranges from very satisfied to very dissatisfied. A global satisfaction score was calculated from these responses and then transformed onto a 0–100 scale (100 being best). Results: Completed questionnaires were received from 2085/3125 patients (67% response rate). 911 respondents had a THR, 866 had a TKR, 157 had a hip resurfacing, 100 had a UKR and 51 had a patellar resurfacing. The mean age of respondents was 70 years and 58% were female. The mean length of follow-up was 28 months. The median satisfaction score was 100 (interquartile range 75–100). However, within the individual outcome domains dissatisfaction rates were: 9% for pain; 12% for overall outcome; 14% for ADLs; and 17% for leisure activities. To explore differences in satisfaction with age, patients were divided into 3 age groups: < 60 years, 60–80 years and > 80 years. The respective rates of dissatisfaction among the age groups were 13%, 11% and 14%, which were not significantly different (p=0.33). In an analysis of gender and satisfaction, significantly more females were dissatisfied than men (14% vs 10%, p=0.01). When pain, function, quality of life, mental health and physical health were compared between patients who were satisfied (n=1834) and dissatisfied (n=251) with their overall outcome, all outcomes were significantly worse in the dis-satisfied patient group (p< 0.001 for all outcomes). Discussion: Although the median satisfaction score in this study was 100, there was a group of patients who were not satisfied with their outcome. As well as having worse joint pain and function, dissatisfied patients also have significantly worse quality of life, physical health and mental health compared to satisfied patients. In conclusion, patient satisfaction is one of the key outcomes that should be strived for after an elective intervention, and these results indicate that joint replacement is failing to fully satisfy a proportion of patients

The aim of this prospective multicentre study was to report the patient satisfaction after total knee replacement (TKR), undertaken with the aid of intra-operative sensors, and to compare these results with previous studies. A total of 135 patients undergoing TKR were included in the study. The soft-tissue balance of each TKR was quantified intra-operatively by the sensor, and 18 (13%) were found to be unbalanced. A total of 113 patients (96.7%) in the balanced group and 15 (82.1%) in the unbalanced group were satisfied or very satisfied one year post-operatively (p = 0.043). . A review of the literature identified no previous study with a mean level of satisfaction that was greater than the reported level of satisfaction of the balanced TKR group in this study. Ensuring soft-tissue balance by using intra-operative sensors during TKR may improve satisfaction. . Cite this article: Bone Joint J 2014;96-B:1333–8

Aims. Advances in arthroscopic techniques for rotator cuff repair have made the mini-open approach less popular. However, the mini-open approach remains an important technique for repair for many surgeons. The aims of this study were to compare the integrity of the repair, the function of the shoulder and satisfaction post-operatively using these two techniques in patients aged > 50 years. Patients and Methods. We identified 22 patients treated with mini-open and 128 patients treated with arthroscopic rotator cuff repair of July 2007 and June 2011. The mean follow-up was two years (1 to 5). Outcome was assessed using the American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) scores, and satisfaction. The integrity of the repair was assessed using ultrasonography. A power analysis ensured sufficient enrolment. Results. There was no statistically significant difference between the age, function, satisfaction, or pain scores (p > 0.05) of the two groups. The integrity of the repair and the mean SST scores were significantly better in the mini-open group (91% of mini-open repairs were intact versus 60% of arthroscopic repairs, p = 0.023; mean SST score 10.9 (standard deviation (. sd. ) 1.3) in the mini-open group; 8.9 (. sd. 3.5) in arthroscopic group; p = 0.003). The ASES scores were also higher in the mini-open group (mean ASES score 91.0 (. sd. 10.5) in mini-open group; mean 82.70 (. sd. 19.8) in the arthroscopic group; p = 0.048). Conclusion. The integrity of the repair and function of the shoulder were better after a mini-open repair than after arthroscopic repair of a rotator cuff tear in these patients. The functional difference did not translate into a difference in satisfaction. Mini-open rotator cuff repair remains a useful technique despite advances in arthroscopy. Cite this article: Bone Joint J 2017;99-B:245–9

Introduction. Depression is a common co-morbidity in Total Hip Arthroplasty (THA). Chronic pain and depression influence one another. Postoperative outcomes and satisfaction rates are affected by depression. Objectives. The aim of the study was to determine the impact of pre-operative depression on patient functional outcomes and satisfaction rates after THA. A secondary objective was to assess potential change in the incidence of depression at mid-term post-operative follow-up. Study Design & Methods. We retrospectively reviewed 200 patients undergoing THA from 2015–2016 at a single academic institution.150 (75%) of patients were followed up at a minimum of 24 months. Patients pre-operative depression symptoms were assessed according to the Zung Self-reported depression score and the PHQ-9 scores. Functional scores, satisfaction rates, expectation rates and 30- and 90-day readmission rates were correlated with pre-operative and 2-year follow-up depression scores. Results. There were 103 females and 47 males with an average age of 60.1 years (22–89 years old). The Patient Health Questionnaire (PHQ-9) correlated with the Zung Self-reported depression scores. Overall, 73 patients (48.7%) were classified as being depressed pre-operatively. There were 48 (32.2%) with mild depression and 19 (12.8%) with marked depression. Females, HIV-infected and morbidly obese patients were more likely to be depressed. The mean pre-operative Harris Hip Score (HHS) was 35.95 (24–66) and Oxford Hip Score (OHS) 17.11 (0–48). The 30-day readmission rate was 2% and all patients were pre-operatively severely depressed. At a minimum of 2 years there was an improvement in Zung Self-Rating Depression Scale and PHQ-9 scores. Only 29 (18.8%) patients were depressed. There were 55 patients who progressed from depressed to non-depressed (p=0.00), while 11 patients (7.4%) became depressed after THA (p=0.00). The least improvement in both OHS and HHS was in the severely depressed group (p<0.05). The overall satisfaction rate was 89.7%. Depressed patient satisfaction rate was 86.9% with only 70.27% of the severely depressed group satisfied post-operatively. Age (>70) and BMI >40 correlated with dissatisfaction (p<0.05). Conclusions. There is a high prevalence of depression in THA. Incorporation of psychological management strategies may improve satisfaction rates and functional outcomes post-THA

Introduction. Robotic systems have been used in TKA to add precision, although few studies have evaluated clinical outcomes. We report on early clinical results evaluating patient reported outcomes (PROs) on a series of robotic-assisted TKA (RAS-TKA) patients, and compare scores to those reported in the literature. Methods. We prospectively consented and enrolled 106 patients undergoing RAS-TKA by a single surgeon performing a measured-resection femur-first technique using a miniature bone-mounted robotic system. Patients completed a KOOS, New Knee Society Score (2011 KSS) and a Veterans RAND-12 (VR-12) pre-operatively and at 3, 6 and 12 months (M) post- operatively. At the time of publication 104, 101, and 78 patients had completed 3M, 6M, and 12M PROs, respectively. Changes in the five KOOS subscales (Pain, Symptoms, Activities of Daily Living (ADL), Sport and recreation function (Sport/Rec) and Knee-related Quality of Life (QOL)) were compared to available literature data from FORCE – TJR, a large, prospective, national cohort of TJR patients enrolled from diverse high-volume centers and community orthopaedic practices in the U.S, as well as to individual studies reporting on conventional (CON-TKA) and computer-assisted (CAS- TKA) at 3M, and on conventional TKA at 6M. The 2011 KSS is a validated method for quantifying patient's expectations and satisfaction with their TKA procedure. Improvements in the 2011 KSS were compared with literature data at 6M post-operatively. Results. RAS-TKA PRO's significantly improved at 3, 6, and 12M from pre-operative baseline values. When compared to the FORCE registry cohort data, the improvement in KOOS subscales were generally higher for RAS for pain at 6M, and for pain, ADL, and QOL at 1Y when compared with FORCE 2Y data. Higher improvements were also seen at 3M, except for Sports/Rec, and at 6M for symptoms and QOL when compared with smaller cohort studies. Improvements in 2011 KSS patient satisfaction and functional scores at 6M were 11 and 10 points greater than those reported for conventional TKA. A mean of 31 pts for the Patient Satisfaction score indicates that on average patients were ‘Satisfied’ with their knee function and pain level. Mean rates of dissatisfaction with knee pain level and function were 9.2%, 3.8% and 3.1% at 3, 6, and 12M postoperatively, respectively. A mean of 10pts for the Expectation score post-operatively indicates that on average patients felt their expectations for pain relief, ADL, and leisure/sports/rec activities were between “Just Right” or “Too Low”. Discussion. Early results of RAS-TKA demonstrated significant improvements in pain, function, and QOL from baseline pre-operative values. PROs for robotic TKA also compared favorably with results reported in the literature; however, additional randomized control studies are required to provide more meaningful comparisons with conventional techniques and with other advanced technologies

Introduction. Despite advances in surgical technique and prosthetics there continues to be a number of patients who are dissatisfied with the results of their knee replacement procedure. The outcome after total knee arthroplasty (TKA) has been reported frequently with use of condition-specific measures, but patient satisfaction has not been well studied. Material and methods. 160 patients who received primary total knee arthroplasty (TKA) were evaluated prospectively to evaluate factors that may be associated with patient satisfaction. At minimum one year follow-up all patients were evaluated and completed validated self-report satisfaction questionnaires. Patient, surgeon, implant and process of care variables were assessed along with WOMAC, Oxford Knee and SF-12 scores. Univariate and multivariate analyses were performed to assess for independent factors associated with post-operative satisfaction. Results. Significant factors associated with post-operative satisfaction include (p<0.05): pre-operative pain and function, presence of comorbidity, post-op complication or stiffness. Age, gender, pre-operative diagnosis, flexion contracture, pre-op range of motion, implant type (fixed vs rotating platform), and surgeon did not significantly affect patient-reported satisfaction (p>0.05). Post-operative function and pain (WOMAC, Oxford Knee Score), comorbidity, and mental status (SF-12 mental) were also highly associated with post-operative satisfaction (p<0.05) at one year post-op. Discussion and conclusion. The primary drivers of patient satisfaction appear to be related to patient-related factors including magnitude of baseline disability and comorbidity as well as the development of any post-op complication. Surgeon and implant related factors do not appear to have a significant effect on satisfaction. Understanding determinants of satisfaction may assist the surgeon and patient when planning for surgery and setting realistic expectations for post-operative outcome

Management of the pathologic long-head biceps tendon remains controversial. Biceps tenotomy is a simple intervention but may result in visible deformity and subjective cramping. Comparatively, biceps tenodesis is technically challenging, and has increased operative times, and a more prolonged recovery. The purpose of this study was to determine the incidence of popeye deformity following biceps tenotomy versus tenodesis, identify predictors for developing a deformity, and compare subjective and objective outcomes between those that have one and those that do not. Data for this study were collected as part of a randomized clinical trial comparing tenodesis versus tenotomy in the treatment of lesions of the long head of biceps tendon. Patients 18 years of age or older with an arthroscopy confirmed biceps lesion were randomized to one of these two techniques. The primary outcome measure for this sub-study was the rate of a popeye deformity at 24-months post-operative as determined by an evaluator blinded to group allocation. Secondary outcomes were patient reported presence/absence of a popeye deformity, satisfaction with the appearance of their arm, as well as pain and cramping on a VAS. Isometric elbow flexion and supination strength were also measured. Interrater reliability (Cohen's kappa) was calculated between patient and evaluator on the presence of a deformity, and logistic regression was used to identify predictors of its occurrence. Linear regression was performed to identify if age, gender, or BMI were predictive of satisfaction in appearance if a deformity was present. Fifty-six participants were randomly assigned to each group of which 42 in the tenodesis group and 45 in the tenotomy group completed a 24-month follow-up. The incidence of popeye deformity was 9.5% (4/42) in the tenodesis group and 33% (15/45) in the tenotomy group (18 male, 1 female) with a relative risk of 3.5 (p=0.016). There was strong interrater agreement between evaluator and patient perceived deformity (kappa=0.636; p<0.001). Gender tended towards being a significant predictor of having a popeye with males having 6.6 greater odds (p=0.090). BMI also tended towards significance with lower BMI predictive of popeye deformity (OR 1.21; p=0.051). Age was not predictive (p=0.191). Mean (SD) satisfaction score regarding the appearance of their popeye deformity was 7.3 (2.6). Age was a significant predictor, with lower age associated with decreased satisfaction (F=14.951, adjusted r2=0.582, p=0.004), but there was no association with gender (p=0.083) or BMI (p=0.949). There were no differences in pain, cramping, or strength between those who had a popeye deformity and those who did not. The risk of developing a popeye deformity was 3.5 times higher after tenotomy compared to tenodesis. Male gender and lower BMI tended towards being predictive of having a deformity; however, those with a high BMI may have had popeye deformities that were not as visually apparent to an examiner as those with a lower BMI. Younger patients were significantly less satisfied with a deformity despite no difference in functional outcomes at 24 months. Thus, biceps tenodesis may be favored in younger patients with low BMI to mitigate the risk of an unsatisfactory popeye deformity

Aims. The primary aim of this study was to assess whether pain in the contralateral knee had a clinically significant influence on the outcome of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary aims were to: describe the prevalence of contralateral knee pain; identify if it clinically improves after TKA; and assess whether contralateral knee pain independently influences patient satisfaction with their TKA. Methods. A retrospective cohort of 3,178 primary TKA patients were identified from an arthroplasty database. Patient characteristics, comorbidities, and WOMAC scores were collected preoperatively and one year postoperatively for the index knee. In addition, WOMAC pain scores were also collected for the contralateral knee. Overall patient satisfaction was assessed at one year. Preoperative contralateral knee pain was defined according to the WOMAC score: minimal (> 78 points), mild (59 to 78), moderate (44 to 58), and severe (< 44). Multivariate regression analysis was used to adjust for confounding. Results. According to severity there were 1,425 patients (44.8%) with minimal, 710 (22.3%) with mild, 518 (16.3%) with moderate, and 525 (16.5%) with severe pain in the contralateral knee. Patients in the severe group had a greater clinically significant improvement in their functional WOMAC score (9.8 points; p < 0.001). Only patients in the moderate (22.9 points) and severe (37.8 points) groups had a clinically significant improvement in their contralateral knee pain (p < 0.001), but they were significantly less likely to be satisfied with their TKA (moderate: odds ratio (OR) 0.64, 95% confidence interval (CI) 0.4 to 0.92, p = 0.022; severe: OR 0.57, 95% CI 0.39 to 0.82, p = 0.002). Conclusion. Contralateral knee pain did not impair improvement in the WOMAC score after TKA, and patients with the most severe contralateral knee pain had a clinically significantly greater improvement in their functional outcome. More than half the patients presenting for TKA had mild-to-severe contralateral knee pain, most of whom had a clinically meaningful improvement but were significantly less likely to be satisfied with their TKA. Cite this article: Bone Joint J. 2020;102-B(1):125–131

Patient satisfaction is not uniform or consistent following revision total knee arthroplasty. This study evaluates ninety-nine patients with a self-administered patient satisfaction questionnaire at a minimum of two years following the revision procedure (1997–99) to determine differences between satisfied (sixty-six patients) and dissatisfied patients (thirty-three patients). Univariate analysis revealed that patients satisfied with their results were significantly different (p< .05) than dissatisfied patients with regards to post op scores including those of the WOMAC pain and function, oxford, and SF-12. Patients were not different with regards to (p> .05) age, comorbidity score, surgical approach, or sepsis as a reason for the revision procedure. Regression analysis demonstrated that gender, post-op WOMAC score, and pre-op arc of motion were significant determinants of satisfaction. The purpose of this study is to evaluate determinants of patient satisfaction following revision total knee arthroplasty. Patient satisfaction with revision knee surgery is most strongly associated with both pre and post-operative descriptors of knee function as well as gender. Understanding the variables associated with satisfaction/dissatisfaction following revision knee arthroplasty may further assist ongoing research efforts to improve the outcomes of this procedure. Univariate analysis revealed that patients satisfied with their results were significantly different (p< .05) than dissatisfied patients with regards to WOMAC pain and function score, oxford knee score, and SF-12. Patients were not different with regards to (p> .05) age, comorbidity score, surgical approach, or presence of sepsis as a reason for the revision procedure. Regression analysis demonstrated that gender, post-op WOMAC score, and pre-op arc of motion were significant determinants of satisfaction (p< .05). A self-administered patient satisfaction survey was completed by ninety-nine patients at a minimum of two years following revision total knee arthroplasty. Fifty-nine patients were females and forty were males. Sixty-six patients were satisfied and thirty-three patients were dissatisfied with the outcome of their surgery at two years post-op. Univariate analysis and multivariate regression suggest that pre and post-operative joint function and gender are the most significant determinants of patient satisfaction

Aims. This study aimed to identify the tibial component and femoral component coronal angles (TCCAs and FCCAs), which concomitantly are associated with the best outcomes and survivorship in a cohort of fixed-bearing, cemented, medial unicompartmental knee arthroplasties (UKAs). We also investigated the potential two-way interactions between the TCCA and FCCA. Methods. Prospectively collected registry data involving 264 UKAs from a single institution were analyzed. The TCCAs and FCCAs were measured on postoperative radiographs and absolute angles were analyzed. Clinical assessment at six months, two years, and ten years was undertaken using the Knee Society Knee score (KSKS) and Knee Society Function score (KSFS), the Oxford Knee Score (OKS), the 36-Item Short-Form Health Survey questionnaire (SF-36), and range of motion (ROM). Fulfilment of expectations and satisfaction was also recorded. Implant survivorship was reviewed at a mean follow-up of 14 years (12 to 16). Multivariate regression models included covariates, TCCA, FCCA, and two-way interactions between them. Partial residual graphs were generated to identify angles associated with the best outcomes. Kaplan-Meier analysis was used to compare implant survivorship between groups. Results. Significant two-way interaction effects between TCCA and FCCA were identified. Adjusted for each other and their interaction, a TCCA of between 2° and 4° and a FCCA of between 0° and 2° were found to be associated with the greatest improvements in knee scores and the probability of fulfilling expectations and satisfaction at ten years. Patients in the optimal group whose TCCA and FCCA were between 2° and 4°, and 0° and 2°, respectively, had a significant survival benefit at 15 years compared with the non-optimal group (optimal: survival = 100% vs non-optimal: survival = 92%, 95% confidence interval (CI) 88% to 96%). Conclusion. Significant two-way interactions between the TCCA and FCCA demonstrate the importance of evaluating the alignment of the components concomitantly in future studies. By doing so, we found that patients who concomitantly had both a TCCA of between 2° and 4° and a FCCA of between 0° and 2° had the best patient-reported outcome measures at ten years and better survivorship at 15 years. Cite this article: Bone Joint J 2021;103-B(2):338–346

Purpose of the study: Patient satisfaction is an important element for patient claims. What is the correlation between patient satisfaction and clinical scores?. Material and methods: An independent investigator reviewed the files of patients who underwent exclusive Chopart arthodesis from 1990 to 2000 and who had at least one-year follow-up. Nineteen patients were reviewed using the AOFAS scale. Patient satisfaction as assessed with two scales, a numerical scale from 1 to 10 and a verbal scale noted 1 to 4. Correlations were made with the perception of the disability due to the operation. Results: Fourteen patients exhibited good correlation between the clinical outcome and their level of satisfaction. Five displayed clear divergence: three poor clinical scores with a high level of satisfaction and two good clinical scores in unsatisfied patients. Discussion: The mean scores were around 6/10. Clinical assessment and satisfaction noted on a scale of 10 gave good agreement: the way satisfaction is approached and the patient’s expression of satisfaction may have an important impact. A visual scale with no semantic connotation would be les subject to interpretation since the assessment is made on a numerical scale independently of psychological implications. Conversely, the disability/satisfaction relationship was scored on a four-point scale and demonstrated rather good agreement as did the relationship between disability and clinical score. Five patients exhibited significant divergence showing that the cultural element and collateral factors (comorbid conditions) could be involved. Conclusion: Establishing a pertinent satisfaction scale is a difficult task because the correlation with the clinical outcome is imperfect. This analysis demonstrated that less than satisfactory objective results can be associated with an acceptable level of satisfaction (three patients in this series). This situation is observed in patients aged over 60 years who grew up in an environment where the physician was to be respected and where complaining was not acceptable. This is a cultural factor. Poor appreciations which contrast with a rather average clinical result are related to collateral conditions which explain such behavior. Patient satisfaction is a multifactorial phenomenon. Reliable information collection before the operation should be helpful in allowing the patient to fine-tune expectations concerning the surgical outcome and the reservations to be expressed

In this study we evaluated whether pre-operative Western Ontario and McMaster Universities (WOMAC) osteoarthritis scores can predict satisfaction following total hip arthroplasty (THA). Prospective data for a cohort of patients undergoing THA from two large academic centres were collected, and pre-operative and one-year post-operative WOMAC scores and a 25-point satisfaction questionnaire were obtained for 446 patients. Satisfaction scores were dichotomised into either improvement or deterioration. Scatter plots and Spearman’s rank correlation coefficient were used to describe the association between pre-operative WOMAC and one-year post-operative WOMAC scores and patient satisfaction. Satisfaction was compared using receiver operating characteristic (ROC) analysis against pre-operative, post-operative and δ WOMAC scores. . We found no relationship between pre-operative WOMAC scores and one-year post-operative WOMAC or satisfaction scores, with Spearman’s rank correlation coefficients of 0.16 and –0.05, respectively. The ROC analysis showed areas under the curve (AUC) of 0.54 (pre-operative WOMAC), 0.67 (post-operative WOMAC) and 0.43 (δ WOMAC), respectively, for an improvement in satisfaction. . We conclude that the pre-operative WOMAC score does not predict the post-operative WOMAC score or patient satisfaction after THA, and that WOMAC scores can therefore not be used to prioritise patient care. Cite this article: Bone Joint J 2015;97-B:150–3

Aims. The primary aim of this study was to assess the rate of patient satisfaction one year after total knee arthroplasty (TKA) according to the focus of the question asked. The secondary aims were to identify independent predictors of patient satisfaction according to the focus of the question. Patients and Methods. A retrospective cohort of 2521 patients undergoing a primary unilateral TKA were identified from an established regional arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 12-Item Short-Form Health Survey (SF-12) scores were collected preoperatively and one year postoperatively. Patient satisfaction was assessed using four questions, which focused on overall outcome, activity, work, and pain. Logistic regression analysis was used to identify independent preoperative predictors of increased stiffness when adjusting for confounding variables. Results. Using patient satisfaction with the overall outcome (n = 2265, 89.8%) as the standard, there was no difference in the rate of satisfaction for pain relief (n = 2277, odds ratio (OR) 0.95, 95% confident intervals (CI) 0.79 to 1.14, p = 0.60), but patients were more likely to be dissatisfied with activities (79.3%, n = 2000/2521, OR 2.22, 95% CI 1.96 to 2.70, p < 0.001) and work (85.8%, n = 2163/2521, OR 1.47, 95% CI 1.23 to 1.75, p < 0.001). Logistic regression analysis identified different predictors of satisfaction for each of the focused satisfaction questions. Overall satisfaction was influenced by diabetes (p = 0.03), depression (p = 0.004), back pain (p < 0.001), and SF-12 physical (p = 0.008) and mental (p = 0.01) components. Satisfaction with activities was influenced by depression (p = 0.001), back pain (p < 0.001), WOMAC stiffness score (p = 0.03), and SF-12 physical (p < 0.001) and mental (p < 0.001) components. Satisfaction with work was influenced by depression (p = 0.007), back pain (p < 0.001), WOMAC function (p = 0.04) and stiffness (p = 0.05) scores, and SF-12 physical (p < 0.001) and mental (p < 0.001) components. Satisfaction with pain relief was influenced by diabetes (p < 0.001), back pain (p < 0.001), and SF-12 mental component (p = 0.04). Conclusion. The focus of the satisfaction question significantly influences the rate and the predictors of patient satisfaction after TKA. Cite this article: Bone Joint J 2018;100-B:740–8

Introduction. There is current debate concerning the most biomechanically advantageous knee implant systems, and there is also currently great interest in improving patient satisfaction after knee arthroplasty. Additionally, there is no consensus whether a posterior-stabilized (PS) total knee device is superior to a more congruent, cruciate-substituting, medially-stabilized device (MS). This study compared the clinical outcomes of two such devices. The primary hypothesis was that the clinical outcomes, and specifically the patient satisfaction as measured by the Forgotten Joint Score, would be better in the MS group. Methods. This prospective, randomized, blinded Level 1 study compared the outcomes of 100 patients who received a Medacta GMK PS device and 101 patients who received a Medacta GMK medially-stabilized Sphere device (Medacta Intl., Lugano, Switzerland). All patients undergoing elective primary total knee arthroplasty were eligible for participation. Institutional Review Board approval and informed consent from participants were obtained. The devices were implanted using an anatomic alignment/calipered- measured resection surgical approach. Clinical and radiographic assessments were performed preoperatively, 6 weeks, 6 months, and annually. Data were compared using T-test with a significance level of 0.05. Results. The minimum follow-up period is 2 years. There were no statistically significant differences in demographic characteristics and preoperative scores; tourniquet time was 7.24% longer for the PS group (40.28 min vs 37.56 min, P < .0086). Alignment was not different between the groups (preoperative or postoperative). There were significant differences between groups for the 1 year and 2 years postop Knee Society scores, Forgotten Joint Score, and ROM; in every case where there was a statistically significant difference, the results were better in the MS group. For example, the FJS was 65.72 in the MS group at 2 years, 54.33 in the PS group (p=0.02). The maximum active flexion at 2 years was 129.75º in the MS group, in the PS group it was 122.27º (p=0.03). Conclusion. The clinical outcomes of the MS group at 1 and 2 years, including the Forgotten Joint Score and flexion, were better statistically, and there was a statistically longer tourniquet time for the PS group. At the minimum 2-year follow-up, the results demonstrate superiority of the medially-stabilized device in terms of multiple clinical outcomes, including patient satisfaction as measured by the Forgotten Joint Score. These findings support the use of a medially-stabilized knee implant system, and support the conclusion that this design, in conjunction with an anatomic alignment, calipered-measured resection surgical technique, offers improved biomechanics and kinematics

Background. Kinematic patterns in total knee arthroplasty (TKA) can vary considerably from the native knee. No study has shown a relation between a given kinematic pattern and patient satisfaction yet. Questions. The purpose of this study was to test whether the kinematical pattern, and more specifically the anteroposterior translation during (1) open kinetic chain flexion-extension, (2) closed kinetic chain chair rising and (3) squatting, is related to the level of patient satisfaction after TKA. Methods. Thirty TKA patients were tested using single plane fluoroscopy. Tibiofemoral kinematics were analyzed for 3 activities of daily living (open chain flexion-extension (FE) and closed chain chair rising (CH) and squatting(SQ)). A two- step cluster analysis was performed which resulted in two clusters of patients based on the KOOS and KSS questionnaires. Cluster 1 (CL1) contained patients with good PROMs, cluster 2 (CL2) contained patients with poorer PROMs. Tibiofemoral kinematics were compared between and within both clusters. Results. Significant worse PROMs were found in cluster 2 for all KOOS and KSS subscores (P<0.001). Open chain movement: Concerning the open chain flexion extension no significant difference was found between the two clusters. Closed chain movements: On the medial side, an initial anterior translation (femur relative to tibia) was found in cluster 1 during early flexion but in cluster 2 this translation was steeper and ran more anteriorly. In mid-flexion a stable medial compartment was found in cluster 1 where cluster 2 started moving posteriorly already. In deep flexion a posterior translation was evaluated in both clusters. Concerning the lateral side, a small initial anterior translation in early flexion was found followed by a posterior translation in mid flexion which continued in deep flexion Cluster 1 moved significantly more posterior in deep flexion. Conclusion. This is one of the first studies to evaluate the influence of total knee kinematics on patient reported outcomes. We found that patients with poorer PROMs experience (1) a more pronounced paradoxical anterior motion on the medial side followed by (2) a less stable medial compartment in mid flexion and (3) less posterior translation in deep flexion on the lateral side

Introduction. Patients who undergo total joint arthroplasty (TJA) are at a high risk for the development of thromboembolic complications. The rate at which venous thromboembolism occurs following TJA has been reported to be between 1.3–9.4%. As a result, the utilization of prophylactic therapies is considered standard of care in this patient population. The primary purpose of the current study was to 1) evaluate patient satisfaction with the use of intermittent compression devices 2) evaluate the risk of self-reported falls secondary to the use of these devices following TJA. Methods. This is a single institution, prospective study on patients who underwent TJA at an urban, academic orthopedic specialty hospital. Patients were surveyed using an electronic patient rehabilitation application regarding their use and satisfaction with their home intermittent compression devices with a battery and power cord attachment that the patient must wear while using the devices. They were also asked if any falls or near-falls they may have experienced. Surveys were administered on postoperative Day 14, and patients were given 10 days to submit their responses. Using our institutions data warehouse, patient demographics were also collected (Table 1). Results. Survey responses were collected from 479 patients who underwent TJA between August 2018 and October 2018. Of the respondents, 278 were female and 201 were male. Approximately 79% of patients in the cohort were satisfied with their use of their compression devices compared to 21% of patients who were unsatisfied. During this time, 16% of patients (75 pts) also reported at least one tripping episode at home and 11 patients (2.3%) had at least one fall at home. Conclusion. These results suggest that patients are generally satisfied with their home intermittent compression devices. There are a significant number of trips or falls after surgery and further study examining the potential role of these devices and their cords in these falls is needed. For figures, tables, or references, please contact authors directly

INTRODUCTION. Successful clinical outcomes following unicompartmental knee arthroplasty (UKA) depend on component positioning, soft tissue balance and lower limb alignment, all of which can be difficult to achieve using manual instrumentation. A new robotic-guided technology has been shown to improve postoperative implant positioning and lower limb alignment in UKA but so far no studies have reported clinical results of robotic-assisted medial UKA. Goal of this study therefore was to assess outcomes of robotic-assisted medial UKA in a large cohort of patients at short-term follow-up. METHODS. This multicenter study with IRB approval examines the survivorship and satisfaction of this robotic-assisted procedure coupled with an anatomically designed UKA implant at a minimum of two-year follow-up. A total of 1007 patients (1135 knees) underwent robotic-assisted surgery for a medial UKA from six surgeons at separate institutions in the United States. All patients received a fixed-bearing metal backed onlay implant as the tibial component between March 2009 and December 2011 (Figure 1). Each patient was contacted at minimum two-year follow-up and asked a series of five questions to determine implant survivorship and patient satisfaction. Survivorship analysis was performed using Kaplan-Meier method and worst-case scenario analysis was performed whereby all patients were considered as revision when they declined study participation. Revision rates were compared in younger and older patients (age cut-off 60 years) and in patients with different body mass index (body mass index cut-off 35 kg/m. 2. ). Two-sided chi-square tests were used to compare these groups. RESULTS. Data was collected for 797 patients (909 knees) with an average follow-up of 29.6 months (range: 22 – 52 months). At 2.5-years follow-up, eleven knees were reported as revised, which resulted in a survivorship of 98.8% (Figure 2). Thirty-five patients declined to participate in the study yielding a worst-case survivorship of 96.0%. Higher revision rates were seen in younger patients (2.60% versus 0.93%, p = 0.09) and in morbidly obese patients (3.36% versus 0.91%, p = 0.03). Of all patients without revision, 92% was either very satisfied or satisfied with their knee function (Figure 3). CONCLUSION. In this multicenter study, robotic-assisted UKA was found to have high survivorship and satisfaction rate at short-term follow-up. Prospective comparison studies with longer follow-up are necessary in order to compare survivorship and satisfaction rates of robotic-assisted UKA to conventional UKA and robotic-assisted UKA to total knee arthroplasty. For any figures or tables, please contact authors directly (see Info & Metrics tab above).

Background. Under- or oversizing of either component of a total knee implant can lead to early component loosening, instability, soft tissue irritation or overstuffing of joint gaps. All of these complications may cause postoperative persistent pain or stiffness. While survival of primary TKA's is excellent, recent studies show that patient satisfaction is worse. Up to 20% of the patients are not satisfied with the outcome as and residual pain is still a frequent occurrence. The goal of this study was therefore to evaluate if the sizing of the femoral component, as measured on a 3D-reconstructed projection, is related to patient reported outcome measures. From our prospectively collected TKA outcome database, all patients with a preoperative CT and a postoperative X-ray of their operated knee were included in this study. Of these 43 patients, 26 (60,5%) were women and 17 (39,5%) were men. The mean age (+/−SD) was 74,6 +/− 9 years. Methods. CT scans were acquired. All patients underwent TKA surgery in a single institution by one surgical team using the same bi- cruciate substituting total knee (Journey II BCS, Smith&Nephew, Memphis, USA). Using a recently released X-ray module in Mimics (Materialise NV, Leuven, Belgium), this module allows to align the post-operative bi-planar x-rays with the 3D- reconstructed pre-operative distal femur and to determine the 3D position of the bone and implant models using the CAD- file of the implant. This new technique was validated at our department and was found to have a sub-degree, sub-millimeter accuracy. Eleven zones of interest were defined. On the medial and the lateral condyle, the extension, mid-flexion and deep flexion facet were determined. Corresponding trochlear zones were defined and two zones were defined to evaluate the mediolateral width. In order to compare different sizes, elastic deforming mesh matching algorithms were implemented to transfer the selected surfaces from one implant to another. The orthogonal distances from the implant to the nearest bone were calculated. Positive values represent a protruding (oversized) femoral component, negative values an undersized femoral component. The figure shows the marked zones on the femoral implant. The KOOS subscores and KSS Satisfaction subscore were evaluated. Results. Two-step cluster analysis based on the clinically relevant zones on both medial (zone 12, 14 and 17) and lateral (zone 2, 5 and 9) femoral condyle of the implant, led to the formation of two clusters. Cluster 1 contained 23 patients with, in general, an undersized femoral component (negative values) whilst cluster 2 contained 20 patients with in general an oversized femoral component (positive values). (see graph) No significant differences were found between both clusters regarding demographics. Regarding PROM data, a significant difference was found for KOOS Symptoms (p=0.037) and a KOOS Pain (p=0.05). Other PROMs are not significantly different between both clusters. Conclusion. Our data shows that undersizing the femoral component results in less postoperative pain and symptoms. The clinical consequence of this study is that in case of in between femoral component sizes, the smallest size should be chosen to diminish the occurrence of postoperative pain and symptoms

Purpose. Total knee arthroplasty (TKA) is one of the most successful surgeries with respect to relieving pain and restoring function of the knee. However, some studies have reported that patients are not always satisfied with their results after TKA. The aim of this study was to determine which factors contribute to patient's satisfaction after TKA. Methods. We evaluated 69 patients who had undergone 76 primary TKAs between March 2012 and June 2013, and assessed patient- and physician- reported scores using the 2011 Knee Society Scoring System and clinical variables before and after TKAs. We determined the correlation between patient satisfaction and clinical variables. Results. The mean (SD) pre-operative score was 8.2 (4.9) for symptoms, 11.5 (4.5) for patient's satisfaction, 13.1 (2.2) for patient's expectations, and 35.4 (18.2) for functional activities. The mean (SD) post-operative score was 16.3 (5.0) for symptoms, 20.7 (6.4) for patient's satisfaction, 9.1 (2.3) for patient's expectations, and 47.4 (19.6) for functional activities. We found that physician- reported scores were higher than patient- reported scores, and improvement in patient- reported scores was lower than that of physician- reported scores following TKA. We did not found a correlation between any pre-operative variables including expectation and post-operative satisfaction. Post-operative symptoms (r=0.51, p<0.01) and functions (r=0.39, p<0.01) correlated with post-operative satisfaction. The predictors of patient dissatisfaction after TKA were remaining symptoms and low postoperative activities. Conclusions. Our study demonstrates that to relieve pain and to restore activities is important for increasing patient satisfaction after TKA. The 2011 Knee Society Scoring System allows surgeons to appreciate differences in the priorities of patients with TKA

Introduction. The application of artificial intelligence (A.I) using patient reported outcomes (PROs) to predict benefits, risks, benefits and likelihood of improvement following surgery presents a new frontier in shared decision-making. The purpose of this study was to assess the impact of an A.I-enabled decision aid versus patient education alone on decision quality in patients with knee OA considering total knee replacement (TKR). Secondarily we assess impact on shared decision-making, patient satisfaction, functional outcomes, consultation time, TKR rates and treatment concordance. Methods. We performed a randomized controlled trial involving 130 new adult patients with OA-related knee pain. Patients were randomized to receive the decision aid (intervention group, n=65) or educational material only (control group, n=65) along with usual care. Both cohorts completed patient surveys including PROs at baseline and between 6–12 weeks following initial evaluation or TKR. Statistical analysis included linear mixed effect models, Mann-Whitney U tests to assess for differences between groups and Fisher's exact test to evaluate variations in surgical rates and treatment concordance. Results. The intervention group showed greater decision quality (K-DQI, Mean difference = 20%, p<0.0001), collaboration in decision-making (CollaboRATE, 12% (intervention group), 47% (control group) below median, p<0.0001), satisfaction with consultations (NRS-C, 14% (intervention group), 33% (control group) below median, p=0.008), improvement in functional outcomes from baseline up to 12 week follow-up (KOOSJR, 4.9 pts higher (intervention group), p=0.029) without significantly impacting consultation time. No differences were observed in TKR rates or treatment concordance. Conclusion. A.I-enabled decision aids incorporating PROs in predictive algorithms can improve decision quality, level of shared decision-making, satisfaction with patient-provider consultations, and functional outcomes, without extending consultation times. The combination of advanced predictive technologies and patient reported data to forecast surgical outcomes presents a paradigm shift in shared decision making and the delivery of high value care for patients with knee OA

Patient satisfaction has only recently gained attention as an outcome measure in orthopaedics, where it has been reported for joint replacement surgery. Little has been published regarding predictors of patient satisfaction in orthopaedic trauma. This study aims to explore the predictors of patient satisfaction, and of surgeon satisfaction, after orthopaedic trauma. Adult patients admitted to hospital with fractures after motor vehicle trauma were surveyed on admission, and at six months. Demographic, injury, socio-economic and compensation-related factors were measured. The two outcomes were satisfaction with progress of the injury, and satisfaction with recovery. The treating surgeons were also surveyed at six months to determine surgeon satisfaction with progress, and recovery (using the same questions), and the presence or absence of fracture union and any complications. Multivariate analysis was used to determine significant predictors of satisfaction for both groups, and satisfaction rates were compared between surgeons and patients using multivariable analysis. Of 306 patients recruited, 232 (75.8%) returned completed questionnaires, but only 141 (46.1%) surgeons responded. Patients rated their satisfaction with progress and recovery as 74.6% and 44.4%, respectively, whereas surgeon-rated satisfaction with progress and recovery was 88.0% and 66.7%, respectively (p< 0.0001). Significant predictors of patient dissatisfaction were: blaming others for the injury, being female, and using a lawyer. Patient-rated outcome was not significantly associated with objective injury or treatment factors. The only significant predictor of surgeon dissatisfaction was fracture non-union. Orthopaedic surgeons overestimated the progress of the injury and the level of recovery compared to patients’ own ratings. Surgeons’ ratings are influenced by objective, treatment-related factors, whereas patients’ ratings were not. Measures of outcome commonly used b y orthopaedic surgeons, such as fracture union, do not predict patient satisfaction

Background. Total knee arthroplasty (TKA) is a proven and cost-effective treatment for osteoarthritis. Despite the good to excellent long-term results, some patients remain dissatisfied. Our study aimed at establishing a predictive model to aid patient selection and decision-making in TKA. Methods. Using data from our prospective arthroplasty outcome database, 113 patients were included. Pre- and postoperatively, the patients completed 107 questions in 5 questionnaires: KOOS, OKS, PCS, EQ-5D and KSS. First, outcome parameters were compared between the satisfied and dissatisfied group. Secondly, we developed a new prediction tool using regression analysis. Each outcome score was analysed with simple regression. Subsequently, the predictive weight of individual questions was evaluated applying multiple linear regression. Finally, 10 questions were retained to construct a new prediction tool. Results. Overall satisfaction rate in this study was found to be 88%. We identified a significant difference between the satisfied and dissatisfied group when looking at the preoperative questionnaires. Dissatisfied patients had more preoperative symptoms (such as stiffness), less pain and a lower QOL. They were more likely to ruminate and had a lower preoperative KSS satisfaction score. The developed prediction tool consists of 10 simple, but robust questions. Sensitivity was 97% with a positive predictive value of 93%. Conclusions. Based upon preoperative parameters, we were able to partially predict satisfaction and dissatisfaction after TKA. After further validation this new prediction tool for patient satisfaction following TKA may allow surgeons and patients to evaluate the risks and benefits of surgery on an individual basis and help in patient selection

A postal questionnaire was sent to 10 000 patients more than one year after their total knee replacement (TKR). They were assessed using the Oxford knee score and were asked whether they were satisfied, unsure or unsatisfied with their TKR. The response rate was 87.4% (8231 of 9417 eligible questionnaires) and a total of 81.8% (6625 of 8095) of patients were satisfied. Multivariable regression modelling showed that patients with higher scores relating to the pain and function elements of the Oxford knee score had a lower level of satisfaction (p < 0.001), and that ongoing pain was a stronger predictor of this. Female gender and a primary diagnosis of osteoarthritis were found to be predictors of lower levels of patient satisfaction. Differences in the rate of satisfaction were also observed in relation to age, the American Society of Anesthesiologists grade and the type of prosthesis. This study has provided data on the Oxford knee score and the expected levels of satisfaction at one year after TKR. The results should act as a benchmark of practice in the United Kingdom and provide a baseline for peer comparison between institutions

Introduction. No previous studies have attempted to measure parental satisfaction and service quality in regards to paediatric orthopaedic service inpatient care. We performed a prospective observational study to assess parental satisfaction with the level of service provided for paediatric orthopaedic inpatient care in our unit. Methods. We employed the validated Swedish parent satisfaction questionnaire to generate parental satisfaction data from 104 paediatric orthopaedic hospital inpatients between August 2009 and May 2010 (49 elective and 55 trauma paediatric orthopaedic admissions, median age range 2–6 years). Questions focused on eight domains of quality: Information on illness, information on routines, accessibility, medical treatment, care processes, staff attitudes, parent participation and staff work environment. Scores generated were a percentage of the maximum achievable for that quality index, for example 100% would correspond to a parent awarding all questions for that index the highest possible score. Results. Overall combined scores for the care indices were highest for parent's perception of ‘medical treatment’ (95%) and ‘staff attitudes’ (95%). The medical treatment index includes questions regarding staff member's skill and competence. Lowest scores corresponded to the index' information routines' (86%). Conclusion. Information routines applies to parental awareness of ward rounds, to whom questions should be directed and which doctors/nursing staff are responsible for their child's care. Lower scores in relation to this index were substantiated by comments from relatives requesting greater information provision. The types of information parents required was routinely provided suggesting that retention rather than lack of information is the main issue. Provision of information pamphlets tailored to common injuries or elective procedures might prove an effective method for improving this aspect of care and increasing overall parental satisfaction with paediatric orthopaedic inpatient service

This study assessed whether patient satisfaction with their hospital stay influences the early outcome of total knee replacement (TKR). During a five year period patients undergoing primary TKR at the study centre had prospectively outcome data recorded (n=2264). Patients with depression (p=0.04) and worse mental wellbeing (p<0.001), according to the short form (SF)-12, were more likely to be dissatisfied with their hospital stay. Decreasing level of satisfaction with their hospital stay was associated with a significantly worse post-operative OKS (p<0.001) and SF-12 score (p<0.001). Multivariable regression analysis confirmed that the patients perceived level of satisfaction with their hospital stay was an independent predictor of change in the OKS (p<0.001) and SF-12 score (p<0.001) after adjusting for confounding variables. Patient satisfaction with their TKR was significantly influenced by their hospital experience, decreasing from 96% in those with an excellent experience to 42% in those with a poor experience. Food, staff/care, and the hospital environment were the most frequent reasons of why patients rated their hospital experience as fair or poor. A patient's perception of their inpatient hospital experience after surgery is an important modifiable predictor of early functional outcome and satisfaction with TKR

There is a paucity of information regarding patient rated expectations of surgery and measures of satisfaction with surgery in terms of specific outcome measures such as pain. The aim of this study was to investigate patient expectations of surgery and short and long term satisfaction with the outcome of decompressive surgery in terms of pain, function, disability, general health. Eighty-four patients undergoing spinal stenosis surgery were recruited into this study. On recruitment into the study patients were also asked to rate their expectations of improved in pain, general health, function etc. In addition at each review stage patients were asked to rate their satisfaction in improvement of these key outcome measures. These demonstrated that patients had very high expectations of recovery particularly in terms of pain and function and that patients were confident of achieving this recovery (76.8%) confident of a good result. Levels of satisfaction however, varied considerably. 41% of subjects were 50% satisfied with the outcome, whilst 30% were dissatisfied. Most patients felt that they had made the right decision to have surgery although the surgery had only achieved 43.4% ± 37.8 of the outcome they had expected. Examination of patient’s expectations of and satisfaction with surgery revealed that frequently patients had unrealistic expectations of their surgery and as a consequence tended to have lower levels of satisfaction

Weber A fractures are a sub-group of ankle fractures parallel or distal to the joint line, below the level of the syndesmosis. Most stable Weber A fractures are managed conservatively with no significant difference in outcome vs. surgical intervention. 1,2. In an effort to ensure staff time was being used as efficiently as possible, a consultant-led virtual fracture clinic (VFC) was introduced to manage Weber A fractures. Patients not requiring immediate surgery were reviewed remotely and, wherever possible, were ‘virtually discharged’ to a nurse-led telephone line. Those with diagnostic uncertainty, unusual features or delayed recovery received a face to face review from a nurse or surgeon. To examine how patients were allocated under this protocol, along with overall patient satisfaction and functional outcome. An audit of satisfaction and outcome was performed of all patients who presented with a Weber A fracture to the ED between October 2011 and October 2012. The minimum follow-up period was two years. A satisfaction and patient reported outcome (5-level-likert-scale, EQ-5D, MOXFQ) measure was conducted via telephone. 3,4. After exclusions, 79 patients were left, of which 63 were successfully contacted (80%). Of the 79 patients included, 33 (42%) required early face-to-face review while 46 (58%) were discharged with advice following discussion at the VFC. Of the 63 successfully contacted, receipt of the information leaflet was recalled by 61 (97%) and 54 (86%) were satisfied with the information they had received. There was no difference in patient satisfaction regarding recovery (p=0.079) or treatment information (p=0.236) provided between avulsion and transverse fractures or in functional outcome according to MOXFQ (p=0.626) or EQ-Vas (p=0.915) scores. Patient satisfaction can remain high without face-to-face consultations following injury. This was demonstrated by the high satisfaction with recovery (83%) and with information provided (86%) and is consistent with current published literature and similar to what would have been achieved with traditional fracture clinic review. 5. The new protocol reduces unnecessary hospital attendances for patients and reduces the burden of unnecessary review in orthopaedic departments. Only 15% of patients required review at a traditional fracture clinic and 27% at a nurse-led clinic, freeing resources for more complex cases

Background. Patient satisfaction after TKR ranges from 75 to 95 percent with 5 to 20 percent of patients who are dissatisfied with their outcome. Noble has shown pain to be the most important factor in patient satisfaction after TKR with others showing patient expectation and increased age to be important. Stability of the flexion gap has been shown by Dennis to be important in wear in the long term, but to our knowledge no study has been done linking stability of the flexion gap to patient satisfaction. Methods. 65 patients underwent a computer navigated TKR with a posterior stabilized fixed bearing prosthesis by a single surgeon. Intraoperative measurements were captured of the flexion gap laxity on varus and valgus stress to evaluate stability of the flexion gap. Patients were divided into a stable group with lift off of 3 mm or less and a lax group with lift off of more than 3 mm on either side. No patient in either group had symptoms of clinical instability. This was correlated with patient satisfaction at one year postoperatively as assessed by telephonic interview. Results. The overall satisfaction rating was 81 percent with 54 out of 65 patients satisfied with the result of their total knee replacement. Of the remaining patients 6 were not satisfied and 5 were not sure. When assessed individually the satisfaction rating was 78 percent in the lax group and 88 percent in the stable group. Flexion gap stability contributes toward patient satisfaction after a TKR and needs to be evaluated more critically. NO DISCLOSURES

Introduction:. Patient Satisfaction after Arthroplasty is being considered as a priority outcome and an important addition to traditional outcome measures. The reported satisfaction rate in the literature is disappointing (75%–89%). Traditional techniques for TKA have made neutral (0° ±3°) coronal alignment a primary technical goal. We present the results of “Ideal Arthroplasty Kinematics” ie a perfectly balanced knee irrespective of mechanical alignment. Materials and Methods:. The primary technical goal was to achieved tensiometer controlled balance, within 2 degrees, of medial and lateral soft tissues throughout range of motion, and equal gap sizes within 2 mm. 864 (92.9%) of 914 patients, operated by one surgeon, between January 2007 and December 2012 were prospectively followed for an average of 40.4 months. They were asked if they were satisfied, unsatisfied or unsure by an independent research-nursing sister. Unsure patients were categorized as unsatisfied. 817 (94.5%) of this group had satisfactory postoperative long leg x-rays as per Paley's technique. The patient satisfaction was correlated to post-operative mechanical axis (M.A.). Results:. 803 (92.9%) of the patients were satisfied with their knees. 719 (88%) had a M.A. within ±3° of neutral; so called “Aligned” knees. 98 (12%) had a M.A. >3°; so called “Outliers”. Patients with aligned knees had a 92.4% satisfaction rate and those that were outliers were satisfied 92.9% of the time. Conclusion:. By attempting to achieve “Ideal Arthroplasty Kinematics” – ensuring the medial and lateral soft tissues are balanced within a couple of degrees using a tensiometer better patient satisfaction has been achieved than previously reported. Knee alignment did not affect satisfaction rate. It seems it is better to leave constitutionally varus patients in varus and similarly valgus patients in valgus

Abstract

Patient satisfaction is a driving force behind setting up and developing day case procedures. Ten months ago a service for day surgery SCARF procedures was set up in Torbay day surgery unit. We analysed patient pre and post operative pain scores and patient satisfaction scores in respect to pain, appearance and overall satisfaction. A questionnaire was sent to all sixty patients who had undergone a SCARF osteotomy in day surgery. Outcomes assessed were: reason for SCARF osteotomy; adequate preoperative information; pain scores pre and post operatively; satisfaction scores and admission rates. 53 patients responded (88% response rate). 79% of patients had their operation for pain, 19% for appearance and footwear, and 2% for function of their foot. 100% of patients were given adequate information by the surgeon preoperatively and 27% also used other sources for information. 62% of patients scored 6 or more on a linear pain score preoperatively. 85% of patients have a current pain score of 0 or 1. 87% were highly satisfied (scoring 9 or 10 on linear scale) with the outcome regarding their pain, 83% highly satisfied with appearance and 72% highly satisfied with function despite the questionnaire being completed less than one year post surgery. 83% of patients were highly satisfied with the overall procedure and 91% said they would have a SCARF as a day case procedure again. 9 patients were admitted, 3 due to living alone, 3 for wound problems and 3 for post anaesthetic problems including pain, nausea and vomiting. From these figures we concluded that SCARF osteotomy in day surgery is a successful, feasible and worthwhile undertaking in our unit. We used the questionnaires and results to further analyse our service and we have made modifications to improve it. We have now put in place a dedicated anaesthetist with an interest in foot and ankle blocks, as well as a comprehensive post operative analgesic regime and a stringent day surgery protocol. We now run a prospective questionnaire from clinic, including AAOFAS scores, to continue analysis of our service. With these changes in place we would like to see our satisfaction scores rising towards 100%

We compared patient satisfaction with surgeon satisfaction after total hip arthroplasty (THA) in a group of 193 patients (200 THAs, mean follow-up six years) using a visual analogue scale (VAS), and two objective and two subjective scoring systems. We also determined the survival rate with different endpoints. For the 121 hips available for clinical follow-up, we did not find a significant difference in satisfaction between patient and surgeon. In a subgroup with low patient satisfaction, the surgeon was more satisfied than the patient (p = 0.04). The correlation between the patient satisfaction VAS and the different subjective and objective scoring systems suggests that pain during activity is the most important factor for the patient. The survivorship at six years decreased from 96.6% to 83.7% if dissatisfaction (VAS > 20) was added to revision as an endpoint in the survival analysis. The patient satisfaction VAS provides additional information to evaluate the outcome of THA. We recommend the use of both subjective and objective scoring systems to evaluate the outcome of THA

Summary Statement. Service industry metrics (the net promoter score) are being introduced as a measure of UK healthcare satisfaction. Lower limb arthroplasty, as a ‘service’, scores comparably with the most successful commercial organisations. Background. Satisfaction with care is important to both the patient and the payer. The Net Promoter Score, widely used in the service industry, has been recently introduced to the UK National Health Service as an overarching metric of patient satisfaction and to monitor performance. This questionnaire asks ‘customers’ if they would recommend a service or products to others. Scores range from −100 (everyone is a detractor) to +100 (everyone is a promoter). In industry, a positive score is well regarded, with those over 50 regarded as excellent. Our aims were to assess net promoter scores for joint arthroplasty, to compare these scores with direct measures of patient satisfaction, and to evaluate which factors contributed to net promoter response. Methods. 6912 individuals undergoing primary lower limb joint replacement over a five year period (Jan 2007 – Dec 2011) took part in a prospective cohort study at a single NHS University hospital. Net promoter score, clinical outcomes as measured by PROMS (Oxford Hip or Knee Score and SF-12 score), multi-faceted patient satisfaction questionnaire, demographic data and length of hospital stay were recorded. Data was collected preoperatively and at 1 year post-surgery. Multivariate regression was performed to determine which factors could predict an outcome of ‘promoter’ and ‘detractor’ at 1 year post-surgery. Significance was accepted at p = 0.1 to accommodate the confounding effect of other variables. Results. Net promoter scores for knee and hip replacements were 49 and 71 respectively. Strong correlation was seen between overall satisfaction and whether the patient would recommend the operation to another (r = 0.637), though regression of these factors was modest (R. 2. = 0.406). Only 4 factors were relevant to the net promoter response: pain relief (OR 2.13, CI 1.83 – 2.49), meeting expectations (OR 2.57, CI 2.24 – 2.97), hospital experience (OR 2.33, CI 2.03 – 2.68) and arthroplasty type (OR 2.31, CI 1.68 – 3.17). These factors drove a model able to explain 95% of the variation in net promoter score. Conclusions. This is the first analysis of net promoter score for joint arthroplasty, and demonstrates values that compare favourably with the services provided by the most successful commercial organizations. The UK Department of Health describes this score as a measure of patient satisfaction. This is perhaps not completely accurate, as only a third of the variation in one response can be explained by the other, suggesting that although clearly related, these concepts are not the same. Pain relief, meeting of expectations of surgery, the hospital experience and whether the hip or knee joint is replaced are the only relevant factors in determining the net promoter response. Factors thought to influence clinical outcome such as depression, number of comorbidities, age and gender carry no influence with this metric

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

Every surgeon needs to audit the quality of his work to ensure that complication rates are low, good function persists for the intermediate term, and patient satisfaction remains high. The use of the 12-point shortened WOMAC score and Orthowave patient satisfaction survey provides enough information for quantitative assessment of most practices. When applied to my hip arthroplasty practice, analysis of data related to 426 consecutive patients at 1–9 years of follow-up (mean 3.5) revealed pain relief was good to excellent in 96%; rate of recommendation of surgery was 97%. Overall satisfaction was good to excellent in 95%. Mean WOMAC scores improved from a preoperative mean value of 32.5 to mean 6.6 at latest follow-up. When the same scoring system was applied to my knee arthroplasty practice, results were surprisingly inferior. Potential areas for technical improvement were then identified and implemented. This study highlights the simplicity and usefulness of the shortened WOMAC score and Orthowave patient satisfaction survey in assessing and improving an arthroplasty practice

Purpose of the study: Why is a surgery patient satisfied, or not satisfied? What is the basis of the patient’s perception of the surgical result and what criteria does a patient use to decide to undergo surgery and then to consider the result satisfactory or not?. Material and methods: All patients consulting a surgeon in the orthopedic and traumatology surgery department during the month of April 2002 received an anonymous questionnaire. The inclusion criteria were an open orthopedic or traumatologic surgical procedure performed by the consulting surgeon, the last procedure performed being considered. Patient satisfaction being multifactorial, several associated factors were tested: pain, comfort, operating room, personnel, anesthesia. Results: Twenty-five questionnaires were collected. One questionnaire was eliminated because of missing data. Operations were undertaken for medical reasons, rarely patient comfort. Postoperative patient satisfaction depended on the patient-physician relationship, and secondarily on outcome. Responses to open questions illustrated that the key element was a quality relationship with the physician. Discussion: This survey had a methodological bias: non-responders often avoid mentioning poor outcome. In this survey, non-responders were non-consulting patients who were not tested. The remarkable fact was that the surgeon was the key to patient satisfaction, more than the result of the operation. The way information was delivered had a primordial importance: the patients expected to be given honest and pertinent information. Conclusion: The feeling of competence and the information delivered are certainly two of the most important points in the patient-surgeon relationship. They are the cement leading to a confident relationship. Information delivery has a personal aspect which each surgeon must manage honestly. The obligation of information delivery is necessary from a regulatory point of view. But it is most important to keep in mind that the way information is delivered is an important aspect which can be assessed via an internal audit. The British National Health Service has demonstrated the usefulness of such audits and the publication of the results as well as the impact on the clientele

In a prospective multicentre study we investigated variations in pain management used by knee arthroplasty surgeons in order to compare the differences in pain levels among patients undergoing total knee replacements (TKR), and to compare the effectiveness of pain management protocols. The protocols, peri-operative levels of pain and patient satisfaction were investigated in 424 patients who underwent TKR in 14 hospitals. The protocols were highly variable and peri-operative pain levels varied substantially, particularly during the first two post-operative days. Differences in levels of pain were greatest during the night after TKR, when visual analogue scores ranged from 16.9 to 94.3 points. Of the methods of managing pain, the combined use of peri-articular infiltration and nerve blocks provided better pain relief than other methods during the first two post-operative days. Patients managed with peri-articular injection plus nerve block, and epidural analgesia were more likely to have higher satisfaction at two weeks after TKR. This study highlights the need to establish a consistent pain management strategy after TKR

Introduction. There is increasing pressure on healthcare providers to demonstrate competitiveness in quality, patient outcomes and cost. Robotic and computer-assisted total knee arthroplasty (TKA) have been shown to be more accurate than conventional TKA, thereby potentially improving quality and outcomes, however these technologies are usually associated with longer procedural times and higher costs for hospitals. The aim of this study was to determine the surgical efficiency, learning curve and early patient satisfaction of robotic-assisted TKA with a contemporary imageless system. Methods. The first 29 robotic-assisted TKA cases performed by a single surgeon having no prior experience with computer or robotic-assisted TKA were reviewed. System time stamps were extracted from computer surgical reports to determine the time taken from the first step in the anatomical registration process, the hip center acquisition, to the end of the last bone resection, the validation of the proximal tibial resection. Additional time metrics included: a) array attachment, b) anatomical registration, c) robotic-assisted femoral resection, d) tibial resection, e) trailing, f) implant insertion, and skin-to-skin time. The Residual Time was also calculated as the skin-to-skin time minus the time taken for steps a) to f), representing the time spent on all other steps of the procedure. Patients completed surveys at 3 months to determine their overall satisfaction with their surgical joint. Results. All time metrics decreased significantly after the first 7 cases, except the residual time (table 1 and figure 1). Mean skin-to-skin time significantly decreased from 83.7min to 57.1min (p=0.0008) beyond 7 cases, and hip center to final cut validation time decreased from 30.2min to 20.3min (p=0.0002). 85.7% (24/29) of patients were “Fully satisfied” and 14.3% (5/29) were “Partly satisfied”. Cost analysis showed there were no capital costs associated with acquisition of the robotic system and per case cost was equal to conventional TKA. Conclusion. Improvements in surgical efficiency and quality are becoming increasing important in today's healthcare environment. The results of this study indicated equal cost, a short learning curve and comparable procedure times to conventional TKA. The Patient Reported Outcomes with this group of patients was very high compared to rates reported in the literature

Many psychological factors have been associated with function after joint replacement. Personality is a stable pattern of responses to external conditions and stimuli. The aim of this study was to investigate the relationship between personality, joint function, and general physical in patients undergoing total hip (THR) and knee replacement (TKR). We undertook a prospective cohort study of 184 patients undergoing THA and 205 undergoing TKA. Personality was assesed using the Eysneck Personality Questionaire, brief version (EPQ-BV). Physical health was measured using the EuroQol (EQ-5D). Joint function was measured using the relevant Oxford Score. Outcomes were assessed at six months. Multivariable models were constructed. The stable introvert personality was most common. Unstable introverts had poorer pre-operative function with hip arthrosis, but not knee arthrosis. Personality was not directly associated with post-operative function – the only independent predictors were pre-operative function (p=0.002) and comorbidity (p<0.001). While satisfaction after TKR was associated with personality (p=0.026), there was no association after THR (p=0.453). The poorest satisfaction was in those with the unstable introvert personality type. Personality was a predictor of preoperative status. It did not have a direct association with postoperative status, but may have as preoperative function was the main predictor of postoperative function, personality may have had an indirect effect. Personality was also a predictor of satisfaction after TKR. This suggests that predicting satisfaction after knee replacement is more complex. Therefore certain patient may benefit from a tailored preoperative education to explore and manage expectations

Background. With the rising demand for primary total hip arthroplasty (THA), there has been an emphasis on reducing the revision burden and improving patient outcomes. Although studies have shown that primary THA effectively minimizes pain and restores normal hip function for activities of daily living, many younger patients want to participate in more demanding activities after their operation. The purpose of this study was to examine the relationship between age, gender and patient satisfaction after total hip arthroplasty. Methods. With IRB approval, 2 groups of subjects were enrolled in this study: (i) 143 patients at an average of 25 months (range 10–69 months) post-primary THA, and (ii) 165 control subjects with no history of hip surgery or hip pathology. All subjects were assigned to one of four categories according to their age and gender: Group A: 40–60 year old males (31 THA; 42 Controls), Group B: 40–60 year old females (25 THA; 53 Controls), Group C: 60–80 year old males (35 THA; 25 Controls), and Group D: 60–80 year old females (36 THA; 23 Controls). Each patient completed a self-administered Hip Function Questionnaire (HFQ) which assessed each subject's satisfaction, expectations, symptoms and ability to perform a series of 94 exercise, recreational and daily living activities. These included participation in work-out activities, adventure and water sports, running and biking, and contact and team sports. Each participant was also asked their activity frequency, symptom prevalence and satisfaction with their hip in performing each activity. Results. When compared to controls, more THA patients reported at least weekly pain (20% vs. 7% p=0.001), stiffness (16% vs. 9% p=0.06), and dependence on analgesics at least weekly (8% vs. 5% p=0.42). Males age 40–60 were the only subgroup to differ significantly from their comparators in regards to pain, stiffness, or analgesic use (pain: 29% vs. 7% p=0.02; stiffness: 29% vs. 5% p=0.007; analgesics: 19% vs. 2% p=0.04). Looking at frequency of pain, more controls were dissatisfied than THA patients (64% vs 21% p=0.02). There were 12% of THA patients reporting their hip does not feel normal compared to 6% of controls (p=0.06); elderly males reported this more frequently than controls (p=0.016) and their elderly female counterparts (p=0.028). Of the effect modifiers tested, sensation of an abnormal hip (p=0.03) and frequent stiffness (p=0.003) portend lower satisfaction ratings while history of THA leads to better satisfaction rating vs. Control (p< 0.0001). Age and sex groups (p=0.33), the presence of pain (p=0.13), and analgesic use (p=0.16) were not significant modifiers. Discussion. Residual symptoms, especially stiffness, and the sensation that their hip is not normal after THA are negatively impact patient satisfaction, yet they are not uncommon in THA patients. Young THA males tend to experience more postoperative symptoms, however they remain satisfied and tolerate these symptoms well. Older THA males are less likely to report a normal feeling hip, but are generally satisfied with the outcome of THA

Background. Both minimally invasive surgery(MIS) and computer-assisted surgery(CAS) in total knee arthroplasty have been scientifically linked with surgical benefits. However, the long-term results of these techniques are still controversial. Most surgeons assessed the surgical outcomes with regard to knee alignment and range of motion, but these factors may not reflect subjective variables, namely patient satisfaction. Purpose. To compare satisfaction and functional outcomes between two technical procedures in MIS total knee arthroplasty, namely computer-assisted MIS and conventional MIS procedure, operated on a sample group of patients after 10 years. Methods. Seventy cases of posterior-stabilized total knee prostheses were implanted using a computer-assisted system and were compared to seventy-four cases of matched total knee prostheses of the same implant using conventional technique. Both groups underwent arthrotomy by 2 centimeter limited quadriceps exposure minimally invasive surgery (2 cm Quad MIS). At an average of ten years after surgery, self-administered patient satisfaction and WOMAC scales were administered and analyzed. Results. Demographic data of both groups including sex, age, preoperative WOMAC and post-operative duration were not statistically different. Post-operative WOMAC for the computer-assisted group was 38.94±5.68, while the conventional one stood at 37.89±6.22. The median of self-administered patient satisfaction scales of the computer-assisted group was 100 (min37.5-max100), while the conventional one was 100 (min25-max100). P-value was 0.889. There was 1 re-operative case in the conventional MIS group due to peri-prosthetic infection which was treated with debridement, polyethylene exchanged and intravenous antibiotics. Conclusion. The long-term outcomes of computer-assisted MIS total knee arthroplasty are not superior to that of the conventional MIS technique. Computer assisted MIS total knee arthroplasty is one of the treatment options for osteoarthritis of the knee that has comparable levels of satisfaction to the conventional MIS technique

Purpose. To determine how patient characteristics; health status and pre-operative knee function effect patient reported satisfaction and operative success following total knee replacement (TKR). We hypothesised that a number of patient factors would influence the reported levels of symptomatic improvement (success) and satisfaction and that these two outcomes would represent different aspects of the patient's perception of outcome. Design. Retrospective cohort analysis of patient reported outcome measures (PROMs) and National Joint Registry (NJR) data. Complete patient data was available for 9,874 TKRs performed for osteoarthritis between 1/8/08 and 31/12/10. The relationship of the background factors to patient perceived satisfaction and success was investigated using ordinal logistic regression and structural equation modelling (SEM). Results. Gender, pre-operative general health, depression, ASA grade and Euroqol index scores individually influenced satisfaction and/or success. When the interactions between variables were considered the size of the improvement in the Euroqol score and female gender were the most important predictors of lower levels of satisfaction/success. The effects of female gender were largely through its association with higher BMI, higher levels of depression and lower levels of general health. In total 8,286 (84%) of patients were satisfied and 8,789 (89%) rated their operation as a success. 712 (8%) of the patients who rated their operation as successful were dissatisfied. This is consistent with the premise that success relates to the patients perception of whether they have symptomatically improved whereas satisfaction relates to the extent to which they are happy with this improvement. Conclusions. Patient perceived satisfaction and success are influenced by a number of patient factors, the most important of which are the improvement in the Euroqol score and gender. This information can be used to counsel patients about the expected outcomes and guide patient selection in cases of borderline clinical need

Introduction: The NHS Contract for Acute Services (April 2008), includes a requirement in Schedule 5 to report on patient reported outcome measures (PROMS). This sets out national standards for elective patients undergoing Primary Unilateral Total Hip Replacements (THR) and Total Knee Replacements (TKR). The recommended instruments for these procedures are the Oxford Hip and Knee Scores. Our aim was to assess whether these instruments accurately assess patient satisfaction and pain and whether a more efficient model could be used. Methods: All patients undergoing primary THR and TKR under the care of the senior author (DH) between Sept 07 – Sept 09 at the RHC Hospital were included in the study. The primary diagnosis in all patients was Osteo-arthritis. All Patients were operated on by DH using the same approach, implants and post-operative rehabilitation programme. Patients were assessed at 6 weeks, 6 months and 1 year post-operatively using the Oxford-12 joint specific score and also by a Visual Analogue Scale (VAS) for pain and satisfaction. The Oxford-12 and VAS scores were then compareded against one another for correlation using scatter-plots and regression analysis. Results:. Primary TKR:. At 6 weeks: Correlation for OKS and pain, OKS and satisfaction, Pain and satisfaction were r = 0.782, 0.736 and 0.796 respectively (p< 0.001). At 6 months: Correlation for OKS and pain, OKS and satisfaction, Pain and satisfaction were r = 0.718, 0.749 and 0.767 respectively (p< 0.001). At 1 year: Correlation for OKS and pain, OKS and satisfaction, Pain and satisfaction were r = 0.7, 0.703 and 0.793 respectively (p< 0.001) Primary THR:. At 6 weeks: Correlation for OHS and pain, OHS and satisfaction, Pain and satisfaction were r = 0.361, 0.309 and 0.477 respectively (p< 0.001). At 6 months: Correlation for OHS and pain, OHS and satisfaction, Pain and satisfaction were r = 0.596, 0.673 and 0.635 respectively (p< 0.001). At 1 year: Correlation for OHS and pain, OHS and satisfaction, Pain and satisfaction were r = 0.682, 0.636 and 0.862 respectively (p< 0.001). Conclusion: The Oxford-12 site specific score correlates extremely well with both VAS scores for pain and patient satisfaction at all time points post-operatively with all values showing a significant (p < 0.001) positive association. Similarly, pain and patient satisfaction scores demonstrate a strong positive association. We propose that rather than using the Oxford-12 score as part of the PROMS assessment, a simple VAS for pain and satisfaction would provide adequate information and would be easier for patients to complete

We conducted a multicentre cohort study of 228 patients with osteoarthritis followed up after total hip or knee replacement. Quality of life and patient satisfaction were assessed by self-administered questionnaires. Patient satisfaction was the dependent variable in a multivariate linear regression model. Independent variables included sociodemographic factors, pre- and post-operative clinical characteristics and the pre-operative and post-discharge health-related quality of life. The mean age of the patients was 69 years (. sd. 9), and 43.8% were male. Pre- and postoperative clinical characteristics were not associated with satisfaction with health care. Only pre-operative bodily pain (p < 0.01) and pre-operative social functioning (p < 0.05) influenced patient satisfaction with care. The pre-operative health-related quality of life and patient characteristics have little effect on inpatient satisfaction with care. This suggests that the impact of the care process on satisfaction may be independent of observed and perceived initial patient-related characteristics

Patient satisfaction is becoming increasingly important as a crucial outcome measure for total knee arthroplasty (TKA). We aimed to determine how well commonly-used clinical outcome scales correlate with patient satisfaction after TKA. In particular, we sought to determine whether patient satisfactions correlate better with absolute postoperative scores or preoperative to 12-month postoperative changes. Patient satisfaction was evaluated using four grades (enthusiastic, satisfied, noncommittal, and disappointed) for 438 replaced knees that were followed for longer than one year. Outcomes scales used AKS, WOMAC and SF-36 scores. Correlation analyses were performed to investigate the relation between patient satisfaction and the 2 different aspects of the outcome scales: postoperative scores evaluated at latest follow-ups and pre- to postoperative changes. The WOMAC function score was most strongly correlated with satisfaction (correlation Coefficient = 0.45). Absolute postoperative scores were better correlated with satisfaction than the pre- to postoperative changes for all scales. This study demonstrates that patient satisfaction correlates better with patient-derived and disease specific scales (WOMAC) than physician-driven (AKS) or generic (SF-36) measures. The present study also shows that absolute postoperative status is more important pre- to postoperative change when determining patient satisfaction

Background. Hip replacement surgery is an effective treatment, however quantitative outcome does not necessarily delineate the true picture. It is important to triangulate data methods in order to ascertain important contextual factors that may influence patient perception. Aims. The aim of the current study was to explore the patient perception on resurfacing hip arthroplasty (RHA) and mini-hip arthroplasty (MHA) in a unique cohort where each patient has received a resurfacing on one side and a mini-hip on the contralateral side using both quantitative and qualitative measures (Fig. 1). Materials and methods. We identified patients in our Practice database that had undergone RHA on one side and MHA in the opposite hip. All prostheses were implanted by two experienced surgeons using a posterior approach and followed a standard anaesthetic protocol, post-operative care and rehabilitation guidelines. The patients received Cormet 2000 hip resurfacing and MiniHip (Corin®, Ciencester, UK) implants. Data were collected pre-operatively and post-operatively at weeks 6, 12, 26 52 and annually thereafter. The data included demographic details, mHHS (modified Harris Hip Score), patient satisfaction and a qualitative semi-structured interview. Data analysis was done using both quantitative (descriptive statistics, student's t-test) and qualitative (constant comparative method of grounded theory). Results. There were 24 hips in 12 patients with mean age of 63.6 years (range 42,81) and a mean follow-up of 5.3 years (SD 4.2). The mean mHHS in pre-operative and one-year post-operative period for RHA was 50.9 (SD 22.9, range 9,71) and 82.6 (SD 11.2, range 67,91) respectively with a mean improvement of 32.9. The mean mHHS in pre-operative and one-year post-operative period for MHA was 47.83 (SD 14.6, range 20,62) and 83.2 (SD 27.3 range 53,94) respectively with mean improvement of 35.3. There was no significant difference in mHHS in the two groups (p=0.26). However, the qualitative analysis showed that a patient's perception of improvement did not always reflect the validated score improvement such as in mHHS. In 8/24 of arthroplasty cases the mHHS indicated a high return to functionality, however, interview highlighted perception of a reduction in certain aspects such as range of movement and ability to perform at a high-level such as competitive windsurfing (2/24), skiing (6/24) or martial arts (2/24). The results, therefore, suggest that the quantitative data is not sensitive enough to deduce return to function in a specialised subset of patients. The interviews indicate a marginal preference for resurfacing due to improved stability. However, the differential to the satisfaction with the mini hip was not sufficient for the potential metal ion problem to be ignored and therefore mini hip was shown to offer a reasonable bone-conserving alternative. Conclusions. Results indicate the need for more than just a quantitative score to demonstrate satisfaction and that RHA generally offers better results although when the metal ion problem is taken into account the MHA can offer sufficient function and satisfaction as an alternative

Introduction. A total knee replacement is a proven cost-effective treatment for end-stage osteoarthritis, with a positive effect on pain and function. However, only 80% of the patients are satisfied after surgery. It is known that high preoperative expectations and residual postoperative pain are important determinants of satisfaction, but also malalignment, poor function and disturbed kinematics can be a cause. The purpose of this study was to investigate the correlation between the preoperative function and the postoperative patient reported outcomes PROMs) as well as the influence of the postoperative functional rehabilitation on the PROMs. Methods. 57 patients (mean 62,9j ± 10,6j), who suffer from knee osteoarthritis and who were scheduled for a total knee replacement at our centre, participated in this study. The range of motion of the knee, the muscle strength of the M. Quadriceps and the M. Hamstrings and the functional parameters (‘stair climbing test’ (SCT), ‘Sit to stand’ (STS) and ‘6 minutes walking test’ (6MWT)) were measured the night before surgery, ±6 months and ±1 year after surgery. This happened respectively with the use of a goniometer, HHD 2, stopwatch and the ‘DynaPort Hybrid’. Correlations between pre- and postoperative values were investigated. Secondly, a prediction was made about the influence of the preoperative parameters on on the subjective questionnaires (KOOS, OXFORD and KSS) as well as a linear and logistic regression. Results. 6 Months after surgery, an improvement of all parameters for ROM, muscle strength and functional status was found. With a significant difference for the active and passive ROM toward knee flexion (p=0.007;p=0.008), asymmetry in active and passive ROM toward flexion between the healthy leg and the leg with the TKA (p=0.001;p=0.001), Quadriceps- and Hamstrings strength (p=0.001;p<0.001), time of the STS test (p=0.012), time sit-stand (p=0.002), time stand-sit (p=0.001;p<0.001), all parameters for the 6MWT and the time of the SCT (p=0.001). Regarding the prediction model, the 6month PROMs can be predicted by some parameters for the 6MWT (distance (p=0.001), gait steps (p=0.002) and step time TKA (p=0.007)). These parameters are predictors for the score on the subscales ‘symptoms’ and ‘pain’ of the KOOS questionnaire. 1 Year after surgery, there is an improvement of all parameters, except for the active and passive ROM toward knee extension. However, these differences are not significant. The 1 year PROMs can only be predicted by the muscle strength (Quadriceps- and Hamstrings strength (p=0.026; p=0.039) and the asymmetry in Quadriceps strength between the healthy leg and the leg with the TKA (p=0.031)). The score on the subscale ‘pain’ can be predicted based on the parameters mentioned above. Conclusion. Patient satisfaction after TKA is a multivariate model. Regarding the functional outcome, we could find that there is a correlation between the muscle force, walking distance and the PROMs. More research is currently being done to create a better prediction model and investigate the correlations more thoroughly

Introduction: Increasing numbers of patients are being treated outside traditional NHS hospitals as part of GSup (General supplemental funding) projects and other initiatives to reduce waiting lists. Concerns regarding these arrangements include case mix at NHS hospitals, quality of clinical care and patient satisfaction. Null Hypothesis: There is no difference between overall patient satisfaction following treatment within the NHS, as part of GSup or as an independent private patient. Methods: Patients undergoing total hip arthroplasty by a single consultant were contacted 6 to 18 months postop. 3 groups were formed; those treated in the local NHS hospital, patients treated as part of GSup and private patients independently financed. A previously validated patient satisfaction questionnaire was completed by each patient. This investigates satisfaction with admission, environment, healthcare professionals, treatment, leaving hospital and overall care. Fisher exact test used to compare groups for significant differences in responses, significance was assumed at p< 0.05 level. Results: 144 of 202 patients responded. Though generally high overall levels of satisfaction were reported, areas of concern were identified, particularly regarding cleanliness of hospital, the availability of nursing staff, maintenance of patient confidentiality and communication with patients. In all cases the GSup patients reported significantly higher levels of satisfaction compared with the NHS patients. 12% of NHS patients felt their overall care fell below “very good” compared with 0% of the GSup patients (p< 0.05). Discussion: Significant differences are identified between NHS and GSup patient satisfaction regarding hospital environment, healthcare professionals and overall standards of care. There were few differences between GSup and private patients treated in the same environment but where they did occur they were universally more positive for the GSup patients. Conclusions: Concerns that GSup patients may be less satisfied with their care appear unfounded; in general they were better satisfied than NHS patients

Introduction: the NHS places emphasis on outcomes and patient partnerships but measuring these factors is problematic. In 2003 the Spinal Assessment Clinic (SAC) moved from an old style hospital to a new PFI building providing an opportunity to audit the influence of environment on operational activity. Objective: Does environment influence satisfaction with care and objective outcome in patients with LBP?. Method: Patients attending the SAC two months prior to relocation and two months following completed a Low Back Outcome Score (LBOS) and a satisfaction survey. Results: The analysis of the satisfaction surveys demonstrated that the patients did not perceive any real difference in the two locations despite the significant age difference, layout and internal standards of the buildings. The satisfaction of patients at both sites was analysed using a number of factors- the care provided was 79% before the move and 82% afterwards, their understanding of a nurse led service was rated as 73% and 85% respectively. Evaluation of the quality of information demonstrated that their questions had been answered well 78% and 75% respectively and the confidence and trust in the person providing the care was 91% and 89%. Failure by the IT department in delivering effective links to hospital computer system resulted in the LBOS data not being completed in the period following the move with logistical difficulties in clinic organisation. Conclusion: despite the difficulty of moving and problems encountered by staff from the SAC the patient did not perceive any alteration in quality

Purpose. To examine how patients viewed the outcome of their joint replacement at least one year post surgery. Emphasis was placed on investigating the relative influence of ongoing pain and functional limitation on patient satisfaction. Method. Questionnaire based assessment of the Oxford Knee Score (OKS), patient satisfaction, and need for reoperation in a group of 10,000 patients who had undergone primary unilateral knee replacement between April and December 2003. Questionnaires were linked to the NJR database to provide data on background demographics, clinical parameters and intraoperative surgical information for each patient. Data was analysed to investigate the relationship between the OKS, satisfaction rate and the background factors. Multivariable logistic regression was performed to establish which factors influenced patient satisfaction. Results. 87.4% patients returned questionnaires. Overall 81.8% indicated they were satisfied with their knee replacement, with 7.0% unsatisfied and 11.2% unsure. The mean OKS varied dependent upon patients' satisfaction (satisfied=22.0, unsatisfied=41.7, unsure=35.2). These differences were statistically significant (p<0.001). Regression modelling showed that patients with higher scores relating to the pain and function elements of the OKS had lower levels of satisfaction (p<0.001) and that ongoing pain was a stronger predictor of lower levels of satisfaction. Other predictors of lower levels of satisfaction included female gender (p<0.05), a primary diagnosis of osteoarthritis (p=0.02) and unicondylar replacement (p=0.002). Differences in satisfaction rate were also observed dependent upon age and ASA grade. 609 patients (7.4%) had undergone further surgery and 1476 patients (17.9%) indicated another procedure was planned. Both the OKS and satisfaction rates were significantly better in patients who had not suffered complications. Conclusion. This study highlights a number of clinically important factors that influence patient satisfaction at one year following TKR. These should act as a benchmark of UK practice and be a baseline for peer comparison between institutions

Introduction: Self-administered questionnaires are commonly used to evaluate functional and satisfaction results of different treatments applied. The objective of the study is to analyze the effect of the doctor-patient interview in the self-evaluation of the patient of the pain, level of function and satisfaction in different shoulder procedures. Material and Method: 95 consecutive patients were recruited. There were 70 females and 25 males. Mean age of 64,18 yo (20–88). There were 28 fracture cases, 37 cuff disorders, 6 instabilities and 21 gleno-humeral arthritis. 46 patients had received surgery while 49 did not. 24 patients were excluded because of wrong complementation of the questionnaire. All the patients were asked to fill 3 analogical scales (level of shoulder pain, level of shoulder function and satisfaction with the procedure) before and after the clinical visit. Non parametric values studied through U-Mann-Whitney. Results: Analyzing the whole series there were significant differences between the pain experienced in the shoulder before and after the visit (p=0,039). There were marginally significant differences between the level of function of the shoulder experienced before and after visit (p=0,061), and there were no differences in satisfaction with the procedure (p=0,462). If the cohort of patients that had received surgery is analyzed apart, there are significant differences in pain perception (p=0,05) and also in function perception (p=0,046) but no differences were noted with satisfaction even though patients tend to perceive more satisfaction after visit. Females significantly considered less pain after visit than males (p=0,034) and no differences were noted because of age, diagnosis or time elapsed since surgery. Conclusions: Globally, patients with shoulder disorders significantly consider to have less pain perception after clinical visit. Patients that had received surgery because of the shoulder disorder significantly perceive less pain and better shoulder function after visit. Satisfaction with the procedure tends to improve after visit but that is not significant. Even a simple analogical scale has a 25% drop-outs because of wrong complementation. When planning patient self-evaluation of pain and function the effect of the clinical visit has to be considered in order to avoid masking results

We have compared the outcome of hemiarthroplasty of the shoulder in three distinct diagnostic groups, using survival analysis as used by the United Kingdom national joint registers, patient-reported outcome measures (PROMs) as recommended by Darzi in the 2008 NHS review, and transition and satisfaction questions. A total of 72 hemiarthroplasties, 19 for primary osteoarthritis (OA) with an intact rotator cuff, 22 for OA with a torn rotator cuff, and 31 for rheumatoid arthritis (RA), were followed up for between three and eight years. All the patients survived, with no revisions or dislocations and no significant radiological evidence of loosening. The mean new Oxford shoulder score (minimum/worst 0, maximum/best 48) improved significantly for all groups (p < 0.001), in the OA group with an intact rotator cuff from 21.4 to 38.8 (effect size 2.9), in the OA group with a torn rotator cuff from 13.3 to 27.2 (effect size 2.1) and in the RA group from 13.7 to 28.0 (effect size 3.1). By this assessment, and for the survival analysis, there was no significant difference between the groups. However, when ratings using the patient satisfaction questions were analysed, eight (29.6%) of the RA group were ‘disappointed’, compared with one (9.1%) of the OA group with cuff intact and one (7.7%) of the OA group with cuff torn. All patients in the OA group with cuff torn indicated that they would undergo the operation again, compared to ten (90.9%) in the OA group with cuff intact and 20 (76.9%) in the RA group. The use of revision rates alone does not fully represent outcome after hemiarthroplasty of the shoulder. Data from PROMs provides more information about change in pain and the ability to undertake activities and perform tasks. The additional use of satisfaction ratings shows that both the rates of revision surgery and PROMs need careful interpretation in the context of patient expectations

Purpose: To identify the determinants of patient satisfaction with outcome after arthroscopic treatment of femoroacetabular impingement. Method: 206 patients underwent arthroscopic treatment of femoroacetabular impingement. Included patients had minimum 1 year follow-up (mean = 16 months; range: 12 to 27 months) with complete demographic, surgical, subjective, and objective data. Average age at time of surgery was 39 years(range:16–77). Outcomes data were collected from modified Harris Hip score(MHHS), Hip outcome score ADL(HOS ADL), Hip outcome score Sports scale(HOS Sport), non-arthritic hip score(NAHS) and patient satisfaction (1=unsatisfied, 10=very satisfied). Dependent variables were patient satisfaction and modified Harris hip score. Independent variables included demographic, surgical, objective and subjective follow-up parameters. Univariate and multivariate analyses were performed to identify determinants of satisfaction and outcome. Results: Average patient satisfaction was 8(range:1–10) and was not normally distributed so nonparametric univariate analysis was used. Average MHHS improved 18 points to 81(range:18–100, p=0.001). Average HOS ADL improved 14 points to 85(range: 28–100, p=0.001). Average HOS Sport improved 22 points to 63(range: 0–100, p=0.001). Average NAHS improved 16 points to 81(range: 0–100, p=0.001. Variables not associated with satisfaction were BMI (p=0.110)(average 24.5 . kg. /. m. 2. ) and preoperative MHHS (p=0.318). Factors associated with patient satisfaction were age(p=0.001), gender(p=0.006), time from onset of symptoms to surgery (p=0.021), joint space (p=0.001), femoral head microfracture (p=0.006), and acetabular microfracture (p=0.001). Satisfaction was related to improvement in MHHS (p=0.001), NAHS (p=0.001), HOS ADL (p=0.001), and HOS Sport (p=0.001). Fifteen(5%) patients underwent total hip arthroplasty at an average of 12.4 months(range: 3.2–24.3 months) post-arthroscopy. Patients who had a joint space less than 2.0mm, were 6.8 times more likely to undergo THA following hip arthroscopy(CI: 2.3–20). Multivariate analysis demonstrated increased satisfaction with increased post-op modified Harris hip score and decreased age(r. 2. =0.57, p=0.0001). Independent predictors of improvement in MHH were age, preoperative MHH and microfracture(r. 2. =0.36, p=0.001). Conclusion: Predictors of increased patient satisfaction include high MHH and absence of microfracture treatment. Patients experienced significant improvement in function at least 1-year postoperatively. This study illustrates the potential of functional improvement and offers patients with FAI a less invasive procedure through arthroscopic methods

In a previous study, we found that pre-TKA patients were severely disabled in high-flexion activities but perceived these disabilities as being no more important than pain relief and the restoration of daily routine activities. This study was conducted to investigate functional disabilities and patient satisfaction in Korean patients after TKA. Of 387 patients who had undergone TKA with a follow-up longer than 12 months, 270 (69.7%) completed a questionnaire designed to evaluate functional disabilities, perceived importance and patient satisfaction. The top 5 severe functional disabilities were difficulties in kneeling, squatting, sitting with legs crossed, sexual activity, and recreational activities. The top 5 in order of perceived importance were difficulties in walking, using a bathtub, working, climbing stairs, and recreation activities. Severities of functional disabilities were not found to be correlated with perceived importance. The patients (8.5%) dissatisfied with their replaced knees had more severe functional disabilities than the satisfied for most activities. The dissatisfied patients tended to perceive functional disabilities in high-flexion activities to be more important than the satisfied. This study indicates that despite severe disabilities in high-flexion activities, most Korean patients after TKA would not consider high-flexion disability to be more important than other daily routine activities. Moreover, postoperative high-flexion disabilities would not adversely influence satisfaction for most patients. Nevertheless, such disabilities are likely to cause dissatisfaction among those that are not prepared to modify their traditional life-styles

Introduction. Pre-operative patient education prior to hip and knee arthroplasty is thought to be beneficial for patients in general, although the clinical effect is unproven. Pre-operative education is now standard practice in many orthopaedic units, including our own. Anecdotally, we found patients in the private sector to be more satisfied with their education than those in the public sector, despite very similar education programs. We set out to investigate this observation and establish whether there were differences in the perception of educational quality between these groups. Methods. After appropriate power calculation, 60 patients in each group (120 total) were interviewed after hip or knee arthroplasty. Satisfaction with education was assessed on a simple 5 point scale and demographic data including internet access was obtained, as well as Short-Form 12 (SF-12) data to establish physical and mental function. The education program in each group was similar, with written material provided and verbal education given at a single pre-operative session. This included specialist nursing and physiotherapy input. Results were analysed with the chi2 test, Mann-Whitney U test and logistic regression as appropriate, with significance at P<0.05. Results. Overall, there was a high level of satisfaction in both groups but patients in the private sector were significantly more satisfied with their pre-operative education. Significant differences were identified between the groups in provision of written information, provision of internet resources, access to the internet, attendance at education sessions and the mental component score of the SF-12. Logistic regression modelling showed that factors influencing satisfaction rates were interdependent. The relationship between lower SF-12 mental component scores and lower satisfaction rates was linear. Conclusion. Private patients are more satisfied with their pre-operative education than public patients, a disparity which may be due to several demographic and educational factors including lower SF-12 mental component scores. The relationships between these factors are complex and not independent. Satisfaction in the public sector may be improved by improving attendance rates at education sessions. However, public patients may not benefit from advances in education that rely on internet access or computer use. Although the use of the internet and computers in general is gaining support, it may not be as beneficial to patients in the public sector as the private sector. This has implications for service provision and planning in arthroplasty units

Objectives:. To establish the demand, referral pathways, utility and patient satisfaction of a physiotherapy led post operative spinal surgery review clinic. Methods:. From July 2014 to January 2015 a pilot physiotherapy led clinic was established. The following clinic data was collected: number of patients reviewed, surgical procedure, outcome of clinic assessment, numbers requiring further investigation, numbers requiring review in the consultant led clinic and adverse events. A patient satisfaction survey was also administered to all English speaking patients. Patients were asked to rate the ease of getting through to the service by phone, length of wait, time spent with the clinician, answers to questions, explanation of results, advice about exercise and return to activities, the technical skills of the clinician, their personal manner and their overall visit. Data was anonymised and inserted into an excel spreadsheet for analysis. Descriptive statistical analysis was undertaken. Results:. 28 patients were reviewed in the pilot clinic. 17 (61%) patients were reviewed and discharged. 11 (39%) patients required discussion with the consultant. The outcome was: Referral for further imaging: n=5 (18%), referral to other specialist: n=2 (6%), consultant led OPD clinic review n=4 (14%) and surgical review of wound n=1 (4%). 84% (n=21/25) of eligible patients completed a post operative satisfaction survey. 86% (n= 18/21) rated their overall visit as excellent. There were no adverse events reported. Conclusion:. The pilot clinic has informed the development of a permanent physiotherapy led post op clinic in the National Neurosurgical Spinal Service and demonstrates the value of interdisciplinary care in this population

Metacarpophalangeal (MP) arthroplasty restores function, corrects deformity and reduces pain in patients with rheumatoid arthritis (RA). In a randomised controlled trial of MP hand reconstruction, we investigated RA patient motivations and expectations and whether self-reported patient satisfaction with appearance, function and pain correlated with objective and subjective outcome measures. From forty patients (one hundred and sixty joints), randomised for an MP arthroplasty trial, we collected preoperative and postoperative objective measures (range of motion (ROM), ulnar drift, JAMAR grip strength), subjective measures (Michigan Hand Questionnaire (MHQ), Sollerman Hand Function test), pre-operative patient-reported motivations and expectations of surgery (appearance, function, pain), and postoperative patient-reported improvement and satisfaction with surgery (appearance, function, pain, overall). Spearman correlations determined associations between patient satisfaction and specific outcome measures. Mean age was 60.3 years, mean disease duration at time of surgery 22.9 years, mean follow-up time 386.4 days, and 87.5% of patients were female. Seven of forty patients (17.5%) rated improved function as the single biggest motivator for surgery, one (2.5%) rated pain, the remainder (80%) rated two or more motivators equally high. Function was rated as the most important or one of the most important motivators for surgery by 92.5% of patients, pain by 67.5% and appearance by 47.5%. Several MHQ subscores (function, work, ADL) were moderately correlated (|rho|=0.67, 0.52, 0.54, respectively), and the Sollerman Score was weakly correlated (|rho|=0.39) with self-reported satisfaction with function, but ROM and grip strength were not (|rho||< 0.25). Self-reported satisfaction scores for appearance, pain and overall were moderately correlated with analogous MHQ subscores (|rho|=0.78, 0.65, 0.71, respectively). Patient expectations of MCP arthroplasty were uniformly high. The greatest motivation for surgery was functional improvement. Pain was highly ranked, but nearly half of the patients rated hand appearance as one of the highest co-ranked motivators. Patient satisfaction correlated poorly with traditional outcome measures (ROM, grip strength) and moderately with subjective outcome measures (MHQ). Aesthetic appearance is probably underrated as a motivator for surgery and determinant of satisfaction

Background. Evaluation of outcomes and satisfaction following hallux valgus (HV) surgery is usually retrospective and rarely uses patient-reported outcome measures (PROMs). Design. Prospective Cohort Study. Postal evaluation survey of patients who had provided pre-operative PROMs data. Methods. Consecutively recruited patients completed the Manchester-Oxford Foot Questionnaire (MOxFQ) prior to surgery. Of 91 patients (124 feet) proceeding to one-stage HV surgery, 69 of 88 eligible patients (78%; 95/124=77% feet) returned a postal follow-up questionnaire including the MOxFQ and a standard satisfaction rating for surgical outcome around 8 years (range 7.4 to 8.9) later. Results. Of the 69 respondents, patients' mean pre-operative age was 49.8 (SD 12.5) years; 66 (95.7%) were female. Of the 95 feet, 78 (82.1%) patients were ‘Very pleased’ or ‘Fairly pleased’ with the outcome, with 17/95 (17.9%) ‘Not very pleased/very disappointed’. Change in all 3 MOxFQ scales showed a significant linear relationship with satisfaction ratings (ANOVA p<0.001) with MOXFQ pain change scores for the ‘very pleased’ response in particular being significantly different from those of other response groups. Conclusions. At around 8 years following HV surgery, the majority of patients were pleased with the outcome. Change in the MOXFQ pain scale is particularly important in interpreting patients' satisfaction with surgery