Patient Dissatisfaction After Primary Total Joint Arthroplasty: The Patient Perspective

Mohamad J Halawi; Walter Jongbloed; Samuel Baron; Lawrence Savoy; Vincent J Williams; Mark P Cote

doi:10.1016/j.arth.2019.01.075

Patient Dissatisfaction After Primary Total Joint Arthroplasty: The Patient Perspective

J Arthroplasty. 2019 Jun;34(6):1093-1096. doi: 10.1016/j.arth.2019.01.075. Epub 2019 Feb 5.

Authors

Mohamad J Halawi¹, Walter Jongbloed², Samuel Baron², Lawrence Savoy¹, Vincent J Williams¹, Mark P Cote¹

Affiliations

¹ Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT.
² University of Connecticut School of Medicine, Farmington, CT.

PMID: 30799270
DOI: 10.1016/j.arth.2019.01.075

Abstract

Background: Despite improvements in surgical technique and implant longevity, some patients continue to report dissatisfaction after total joint arthroplasty (TJA). As patient satisfaction is increasingly used as a quality metric, the objective of this study was to gain better understanding of satisfaction with total joint arthroplasty from the patient perspective.

Methods: Five hundred fifty-one primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) with a minimum of 1-year follow-up and were responsive to a satisfaction survey were analyzed. The incidence, predictive factors, and subjective reasoning for patient dissatisfaction were assessed. Univariate and multivariate logistic regression analyses were performed.

Results: Patient satisfaction was 89% for THA and 88% for TKA. Hispanic race was the most significant predictor of dissatisfaction (P = .037). The most common reasons for dissatisfaction after THA were persistent pain (N = 14/34, 41%), functional limitation (N = 12/34, 35%), surgical complication and reoperation (N = 4/34, 12%), staff or quality of care issues (N = 2/34, 6%), and slow recovery (N = 2/34, 6%). The most common reasons for dissatisfaction after TKA were persistent pain (N = 19/46, 41%), functional limitation (N = 12/46, 26%), surgical complication and reoperation (N = 8/46, 17%), staff or quality of care issues (N = 5/46, 11%), and unmet expectations (N = 2/46, 4%).

Conclusion: While persistent pain and functional limitation are the 2 leading reasons for dissatisfaction in both TKA and THA, a subset of patients view satisfaction as an evaluation of the process by which care is delivered. Patient satisfaction is not solely a reflection of surgical outcome and should be interpreted with caution. Potential for incomplete pain relief or full functional recovery should be discussed during preoperative counseling. Empathic care is also important and should be encouraged to enhance the overall patient experience.

Keywords: arthroplasty; hip; knee; patient perspective; patient satisfaction; risk factors.

MeSH terms

Aged
Arthroplasty, Replacement, Hip / psychology*
Arthroplasty, Replacement, Knee / psychology*
Female
Humans
Male
Middle Aged
Odds Ratio
Patient Satisfaction / statistics & numerical data*
Preoperative Care
Prospective Studies
Recovery of Function
Regression Analysis
Retrospective Studies
Surveys and Questionnaires
Treatment Outcome