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(AAOS2014): To clinical, demographic, and mental-health factors that predict a good outcome from total knee arthroplasty, add one simple independent factor: The patient's determination to reach full function, and confidence in doing so.
Some factors are known to forebode a bad experience with knee replacement: Preoperative depression, older age, comorbidities, and low socioeconomic status. After controlling for all of these, a team at the Cleveland Clinic has isolated one predictor of success that can stand on its own: The patient's determination to return to full function, and confidence in the likelihood of doing so.
It's also known that patients who place a high value on returning quickly to work after TKA are more likely to do so, Joseph Styron MD and his coauthors point out in a poster presented at the annual American Academy of Orthopaedic Surgeons meeting in New Orleans. Their study refined the question from motivation to confidence, asking patients scheduled for primary unilateral total knee arthroplasty (TKA) to state both their desired level of functional activity after surgery on a scale from 1 to 5 (from mere self-care to participating in sports), as well as their level of confidence in their ability to do so, on a 1-to-10 scale.
At scheduled periods after surgery, they asked the same patients to complete two other questionnaires: the 12-item Short-Form Health Survey (SF-12) and a Knee injury and Osteoarthritis Outcome Score (KOOS). Among 1,735 patients who completed at least one follow-up questionnaire, followed for an average of 15.5 months, the stated level of confidence before surgery was significantly and consistently associated with higher scores for all of the self-reported outcome measures: the physical component of the SF-12 (p<0.001), function and pain as assessed by KOOS (p=0.003 and p=0.025, respectively) and a higher self-reported physical activity scale (p=0.001).
The bottom line? After taking account of the clinical and demographic factors, carefully identifying a patient's expectations before TKA can help to manage and improve satisfaction with the outcome.