DOES PATIENT PERCEPTION OF ALIGNMENT AFFECT OUTCOME IN TOTAL KNEE ARTHROPLASTY?

Abstract

A prospective evaluation was undertaken utilizing the SF12 score, Oxford Knee score, Knee Society Score (KSS), visual analog pain score, and a non-validated questionnaire to determine patient self-perception of leg alignment after knee arthroplasty, and impact of satisfaction with alignment on clinical outcomes. 21/84 (25%) patients were dissatisfied with their new leg alignment and this group subsequently reported greater pain scores (p< 0.001) and lower SF12 scores (p< 0.002). Oxford Scores and KSS showed no difference between groups. We suggest that patient satisfaction with postoperative lower extremity alignment is an important issue affecting subjective outcomes in total knee arthroplasty (TKA).

This study was undertaken to determine how patients perceive their leg alignment after knee arthroplasty and whether their level of satisfaction with alignment affects clinical outcomes.

The results of this study suggest that there may be some benefit to preoperative counselling on what to expect in regard to leg alignment following surgery. Additionally, given the adverse impact of dissatisfaction with limb alignment on subjective outcomes, we suggest that patient satisfaction regarding leg alignment should be considered for inclusion in the design of subjective outcomes measures for total knee arthroplasty.

21/84(25%) patients were dissatisfied with their new leg alignment while all but one had an anatomic axis between 4–100 valgus radiographically. This group subsequently reported greater pain scores (p< 0.001) and lower SF12 scores (p< 0.002). At six months follow-up, there was no difference between groups on the Oxford Knee or KSS (p> 0.05).

A non-validated questionnaire was utilized to prospectively ask patients to self-rate their alignment, their satisfaction with their alignment, and their pain scores on a visual analog scale (VAS). Additional outcome measures included pre and postoperative SF-12, Oxford Knee and KSS.

There is still no consensus regarding any one single scoring system with regard to clinical outcomes of primary TKA. Also, it has been widely reported that surgeons often perceive outcomes of TKA with more success than patients. 21/84 of our patients were dis-satisfied with their alignment while all but one had an anatomic axis between 4–100 valgus radiographically.