KS24: SPEAKING OF SUCCESS IN TKA – DOES LANGUAGE MATTER?

Abstract

Australia is a society with a diverse mix of people, cultures and languages. Patients presenting at our institution in 2006 who underwent TKA originated from 39 countries and 14 different languages were represented. Little is reported on the outcomes for non-English speaking patients undergoing Orthopaedic surgery. We conducted a prospective study to determine if outcomes were comparable for English and non-English patients undergoing TKA. A prospective observational study of 278 consecutive, primary TKA was undertaken from January to December 2006. Pre-operative Body Mass Index (BMI), patient demographics, co-morbidities, operative data, complications, length of stay and discharge destination were recorded. Functional status was measured preoperatively and 12 months post TKA using the International Knee Society Score (IKS). An interpreter was used for non-English speaking patients for Surgeon assessment and consent, pre-admission assessment and during the in-patient stay. A total of 41 patients (15%) were non-English speaking and of these 38 were female. No patient was lost to follow-up and 94% of patients completed the IKS evaluation at 12 months. The median age, ASA scores and number of co-morbidities were comparable between English and non-English speaking patients presenting for TKA. Median BMI was higher in the non-English speaking group 33.2 kg/m2 compared to English speaking 30.9 kg/m2, (p=0.010). There were no differences in the length of stay, discharge destination or complication rates between the 2 groups. Median preoperative IKS scores were poorer in non-English speaking patients (61) compared to English speaking patients (72), (p=0.002). At 12 months the difference in IKS scores between the 2 groups was even greater. The median score for non-English speaking patients was (116), compared to (142) in English speaking patients. Of the total IKS evaluation, poorer ratings for pain was the predominant cause for the lower scores in non-English speaking patients compared to English speaking patients, p=0.016. Active flexion was also slightly poorer at 12 months in non-English speaking patients 102° compared to English speaking patients 110°, (p=0.075). As there were significant differences in BMI and gender between English speaking and non-English speaking patients, we analyzed English speaking patients separately for differences in outcomes according to BMI and gender. We found no difference in the IKS scores based on these variables.

Although non-English speaking patients undergoing TKA achieved comparable outcomes in the acute phase following surgery, this did not equate to achieving the same functional result at 12 months, compared to English speaking patients. Pain was the predominant cause for poorer results. Further exploration of patient expectations and pain management is required for non-English speaking patients.