Exploration of adverse consequences of total knee arthroplasty by patients and knee specialists: a qualitative study

Objectives

A successful outcome according to the knee specialist is not a guarantee for treatment success as perceived by patients. This study explored outcome expectations and experiences of patients with osteoarthritis (OA) before and after total knee arthroplasty (TKA) surgery and knee specialists that may contribute to the negative appraisal of its effect, and differences in views between patients and knee specialists.

Methods

Semi-structured interviews were held in Belgium and the Netherlands. Twenty-five patients (2 without TKA indications, 11 on the waiting list for TKA and 12 postoperative TKA), and fifteen knee specialists (9 orthopaedic surgeons, 1 physician assistant, 1 nurse practitioner, and 4 physiotherapists) were interviewed. Conversations were audio recorded, transcribed verbatim, and analysed using thematic analysis following the grounded theory approach. Separate analyses were conducted for patients and knee specialists.

Results

Patients were focused on the arduous process of getting used to the prosthesis, lingering pain, awareness of the artificial knee and limitations they experience during valued and daily activities, while knee specialists put emphasis on surgical failure, unexplained pain, limited walking ability and impairments that limit patients’ physical functioning.

Conclusion

This study provides a comprehensive overview of potential adverse consequences from the perspective of both patients and knee specialists. Improving patients’ awareness and expectations of adaptation to the knee prosthesis needs to be considered.

Lay summary

What does this mean for patients?

Many people with serious complaints due to knee osteoarthritis benefit from knee replacement surgery. This is not the case for approximately 20% of the people. “No benefit” or “not happy” can mean: too much pain, not able to bend the knee, limited walking ability, or a rehabilitation that takes too long. There are many different opinions and the view of the orthopaedic surgeon can be different of that of the patient. We interviewed patients and knee specialists on the negative consequences of a knee replacement surgery and described whether these views differed. We found that patients were more focused on the difficult process of getting used to the prosthesis, lingering pain, awareness of the prosthetic knee and limitations they experience during valued daily activities, while knee specialists were more focused on surgical failure (ie infections, prosthetic loosening), unexplained pain, and impaired physical functioning. We concluded that the difficult process of adapting to the knee prosthesis should be better discussed with patients during preoperative consultation.