• Manipulation under anaesthesia
• Orthopedic surgery
• Postoperative complications
• Predictive factors
• Total knee replacement

• Humans
• Arthroplasty, Replacement, Knee
• Female
• Male
• Aged
• Middle Aged
• Risk Factors
• Retrospective Studies
• Manipulation, Orthopedic
• Anesthesia
• Range of Motion, Articular
• Postoperative Complications
• Aged, 80 and over
• Age Factors

• Humans
• Arthroplasty, Replacement, Knee/rehabilitation
• Quality of Life
• Female
• Male
• Prospective Studies
• Aged
• Middle Aged
• Patient Satisfaction
• Resistance Training/methods
• Blood Flow Restriction Therapy
• Patient Reported Outcome Measures
• Osteoarthritis, Knee/surgery
• Muscle Strength/physiology
• Recovery of Function

• Research Foundation Flanders

• OMERACT-OARSI responder
• joint replacement
• mental health
• patient-reported outcome measures
• satisfaction
• total knee replacement

• Humans
• Arthroplasty, Replacement, Knee/psychology
• Aged
• Male
• Female
• Anxiety/etiology
• Anxiety/psychology
• Sweden
• Depression/psychology
• Depression/etiology
• Middle Aged
• Registries
• Osteoarthritis, Knee/surgery
• Osteoarthritis, Knee/psychology
• Patient Satisfaction
• Patient Reported Outcome Measures
• Pain, Postoperative/psychology
• Pain, Postoperative/etiology
• Aged, 80 and over

• Humans
• Arthroplasty, Replacement, Knee
• Osteoarthritis, Knee/surgery
• Osteoarthritis, Knee/psychology
• Female
• Depression/etiology
• Male
• Aged
• Prospective Studies
• Middle Aged
• Preoperative Period
• Cohort Studies
• Treatment Outcome

• functional outcome
• long-term outcome
• primary total knee arthroplasty
• quality of life

• Humans
• Female
• Aged
• Male
• Arthroplasty, Replacement, Knee
• Osteoarthritis, Knee/surgery
• Quality of Life
• Longitudinal Studies
• Treatment Outcome
• Knee Joint/surgery

• Aged
• Arthroplasty, Replacement, Knee
• Female
• Follow-Up Studies
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Pain, Postoperative/diagnosis
• Pain, Postoperative/etiology
• Quality of Life
• Recovery of Function

• Arthroplasty
• Humans
• Machine Learning
• Reoperation
• Retrospective Studies

Globally the volume of total knee arthroplasty (TKA) is on the rise, reflecting aging populations, an associated increase in treatment of osteoarthritis, and a desire for improved quality of life. There is evidence that as high as 15 to 20% of patients are not satisfied with their TKA results and efforts need to be made to improve these rates. This study set out to identify what patients consider important when reflecting on TKA satisfaction, to pave the way to identifying service transformation opportunities that will enhance patient-centred care and satisfaction with this procedure.

Twenty-seven TKA recipients were recruited in the province of British Columbia, Canada. Semi-structured interviews were conducted about participants’ experience and satisfaction with TKA, three to four years post-surgery. Grounded theory was employed to analyze participants’ stories about what was front of mind when they reflected on satisfaction with their new knee.

Participants described their post-TKA knee in terms its adequacy: how it felt and worked, and how it matched their pre-surgical expectations. The central element of their stories was the process of adapting, which gave rise to their perceptions of adequacy. Adapting comprises the patient experience of physically integrating and cognitively accepting their new knee. Patterns of adapting reflect the level of the new knee’s achieved adequacy and the straightforwardness of the adapting process.

The conceptualization of adequacy and the process of adapting allow a patient-centred understanding of what patients experience following TKA. For participants who did not readily achieve the adequacy they had anticipated, the challenges they experienced during adapting dominated their stories. Participants’ adapting stories afford key insights into how the health care system could adjust to better support TKA patients, and improve rates of satisfaction with this procedure.

The process of adapting lends itself to system intervention in support of enhanced post-TKA outcomes and satisfaction. These interventions could include the development of a care model including long-term clinical support for patients whose knees do not achieve desired results on schedule, and collaborating with patients to set and manage reasonable expectations about how their post-TKA knee will feel and function.

• Adapting
• Grounded theory
• Patient experience
• Patient satisfaction
• Qualitative research
• Total knee arthroplasty

• long-term outcomes
• patient dissatisfaction
• patient reported outcomes
• predictors
• primary knee arthroplasty
• total joint arthroplasty

• Intraoperative pressure sensors
• Knee injury and Osteoarthritis Outcome Score
• Knee replacement
• Soft-tissue balance
• Total knee arthroplasty
• clinical and functional outcomes
• functional outcomes
• knees
• multicentre randomized controlled trial
• patient-reported outcome measures (PROMs)
• randomized trial
• soft-tissue balance
• t-tests
• total knee arthroplasty (TKA)

• depression
• functional outcome
• patient-reported outcome
• subclinical hypothyroidism
• total knee arthroplasty

• Aged
• Female
• Humans
• Male
• Mental Health
• Middle Aged
• Musculoskeletal Pain/diagnostic imaging
• Musculoskeletal Pain/physiopathology
• Musculoskeletal Pain/psychology
• Osteoarthritis, Hip/diagnostic imaging
• Osteoarthritis, Hip/physiopathology
• Osteoarthritis, Hip/psychology
• Osteoarthritis, Knee/diagnostic imaging
• Osteoarthritis, Knee/physiopathology
• Osteoarthritis, Knee/psychology
• Patient Reported Outcome Measures
• Radiography

While total knee arthroplasty (TKA) and total hip arthroplasty (THA) lead to excellent clinical outcomes, some patients experience residual surgical site pain and reduced satisfaction. This prospective observational study investigated the prevalence of preoperative and postoperative residual central sensitization (CS) after TKA and THA. The influence of residual CS on the improvement in quality of life (QOL) was also investigated.

The participants were 40 patients who underwent TKA and 47 patients who underwent THA. CS was measured using the central sensitization inventory (CSI) questionnaire. Knee symptoms were evaluated using the Knee Injury and Osteoarthritis Outcome Scales (KOOS), and hip symptoms were evaluated using the Japanese Orthopedic Association Hip-disease Evaluation Questionnaires (JHEQ). General QOL was evaluated using EuroQOL (EQ-5D-5l). Regression analysis was performed to estimate factors related to low QOL after surgery.

Preoperatively, 47.5% of TKA patients and 66.0% of THA patients were CS positive (P=0.083), which reduced to 10.0% (P=0.042) and 25.5% (P=0.202), respectively, 3 months after surgery. Although the improvements in KOOS subscales and EQ-5D-5l scores in TKA patients with residual CS were significantly lower than in those without residual CS, residual CS status had no effect on JHEQ subscales and EQ-5D-5l scores in THA patients. Regression analysis indicated that EQ-5D-5l was negatively correlated with CSI in the TKA group (P=0.017). In contrast, CSI was not correlated with EQ-5D-5l in the THA group (P=0.206).

Postoperative QOL improvement was achieved 3 months after THA regardless of residual CS status. In contrast, preoperative CS was negatively associated with the improvement in QOL after TKA.

One in five patients report chronic pain following total knee arthroplasty (TKA) and are considered non-improvers. Psychological interventions such as cognitive behavioral therapy (CBT), combined with exercise therapy and education may contribute to reduced pain an improved function both for patients with OA or after TKA surgery, but the evidence for the effectiveness of such interventions is scarce. This randomized controlled trial with three arms will compare the clinical effectiveness of patient education and exercise therapy combined with internet-delivered CBT (iCBT), evaluated either as a non-surgical treatment choice or in combination with TKA, in comparison to usual treatment with TKA in patients with knee OA who are considered candidates for TKA surgery.

The study, conducted in three orthopaedic centers in Norway will include 282 patients between ages 18 and 80, eligible for TKA. Patients will be randomized to receive the exercise therapy + iCBT, either alone or in combination with TKA, or to a control group who will undergo conventional TKA and usual care physiotherapy following surgery. The exercise therapy will include 24 one hour sessions over 12 weeks led by a physiotherapist. The iCBT program will be delivered in ten modules. The physiotherapists will receive theoretical and practical training to advise and mentor the patients during the iCBT program. The primary outcome will be change from baseline to 12 months on the pain sub-scale from the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes include the remaining 4 sub-scales from the KOOS (symptoms, function in daily living, function in sports and recreation, and knee-related quality of life), EQ-5D-5L, the Pain Catastrophizing Scale, the 30-s sit-to-stand test, 40-m walking test and ActiGraph activity measures. A cost-utility analysis will be performed using QALYs derived from the EQ-5D-5L and registry data.

This is the first randomized controlled trial to investigate the effectiveness of exercise therapy and iCBT with or without TKA, to optimize outcomes for TKA patients. Findings from this trial will contribute to evidence-based personalized treatment recommendations for a large proportion of OA patients who currently lack an effective treatment option.

Clinicaltrials.gov: NCT03771430. Registered: Dec 11, 2018.

• Cognitive behavioral therapy
• Exercise therapy
• Osteoarthritis
• Total knee arthroplasty

• Correction rate
• Hospital for special surgery knee score
• Neutral alignment
• Total knee replacement

• PROMs
• knee
• longitudinal data analysis
• patient-reported outcomes
• satisfaction
• total knee arthroplasty

• arthroplasty
• gait
• satisfaction

• Function
• Outcomes
• Patient satisfaction
• Prognosis
• Total knee arthroplasty

• anxiety
• arthroplasty
• depression
• knee
• precision
• recovery
• rehabilitation
• resilience

• ACE inhibitors
• ARBs
• Angiotensin
• Extension
• Flexion
• Range of motion
• Total knee arthroplasty

Total knee arthroplasty is a common procedure with generally good results. However, there are still patients who are dissatisfied without known explanation. Satisfaction and dissatisfaction have previously been captured by quantitative designs, but there is a lack of qualitative studies regarding these patients’ experiences. Qualitative knowledge might be useful in creating strategies to decrease the dissatisfaction rate.

Of the 348 patients who responded to a letter asking if they were satisfied or dissatisfied with their surgery, 61 (18%) reported discontent. After excluding patients with documented complications and those who declined to participate, semi-structured interviews were conducted with 44 patients. The interviews were analyzed according to qualitative content analysis. The purpose was to describe patients’ experiences of discontentment 1 year after total knee arthroplasty.

The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and lacking of relational supports. They were bothered by pain and stiffness, and worried that changes were complications as a result of surgery. They described inability to perform daily activities and valued activities. They also felt a lack of relational supports, and a lack of respect and continuity, support from health care, and information adapted to their needs.

Patient expectation seems to be the major contributing factor in patient discontentment after knee replacement surgery. This qualitative study sheds light on the on the meaning of unfulfilled expectations, in contrast to previous quantitative studies. The elements of unfulfilled expectations need to be dealt with both on the individual staff level and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient satisfaction after surgery.

• Content analysis
• Patient contentment
• Patient satisfaction
• Qualitative research
• Surgery
• Total knee arthroplasty

• Clinical results
• Observational study
• Total knee prosthesis revision

• Knee stiffness
• Mobilisation under anaesthesia
• Total knee arthroplasty
• Total knee replacement
• Young patients

The fabella is a sesamoid bone of the knee that can degenerate in some patients with osteoarthritis. The purpose of this study was to examine the prevalence and degeneration grades of fabellae in the Chinese population and to analyse their relationships with subject ages and knee osteoarthritis grades. The anteroposterior and lateral knee roentgenograms of 1150 subjects were recruited from the institutional database. The Kellgren-Lawrence scoring system was used to evaluate knee osteoarthritis. The degeneration grades of fabellae were scored in lateral roentgenograms by screening their shapes, sizes, subchondral sclerosis and osteophyte formation. The prevalence and degeneration of fabellae among ages, genders and knee sides were analysed by the Pearson Chi-Square test, and their relationships with knee osteoarthritis were analysed by the Spearman nonparametric correlation test. The overall prevalence of fabellae was 48.6% in 1359 knees. There was no significant difference in fabellar prevalence between the two sides (χ² = 0.025, P = 0.87437) and genders (χ² = 3.647, P = 0.05617), while the prevalence increased with the increasing ages of the subjects (χ² = 213.868, P < 0.001). The fabellar degeneration grades were correlated with age (r = 0.5288, P < 0.001) and knee osteoarthritis scores (r = 0.6892, P < 0.001). These results suggested that the fabellar prevalence and degeneration grades were correlated with age and knee osteoarthritis scores.

• Arthroplasty
• Asymmetry
• Satisfaction
• Stair biomechanics
• Total knee replacement

• intraoperative
• soft-tissue balance
• total knee arthroplasty

• Aged
• Arthroplasty, Replacement, Knee/methods
• Biomechanical Phenomena
• Female
• Humans
• Knee Joint/physiopathology
• Knee Joint/surgery
• Male
• Middle Aged
• Monitoring, Intraoperative/methods
• Osteoarthritis, Knee/surgery
• Postural Balance/physiology
• Pressure
• Quality of Life
• Range of Motion, Articular
• Walking/physiology

• Smith and Nephew, Australia
• OrthoSensor (Dania Beach FL, USA)

• Articular coupling
• Ceramic
• Diabetes
• Metal
• Polyethylene
• Septic loosening

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/instrumentation
• Cementation
• Female
• Hip Prosthesis/adverse effects
• Humans
• Male
• Middle Aged
• Prosthesis Design/adverse effects
• Prosthesis Failure/adverse effects
• Prosthesis-Related Infections/etiology
• Prosthesis-Related Infections/surgery
• Prosthesis-Related Infections/therapy
• Registries
• Reoperation
• Risk Factors
• Young Adult

Total knee arthroplasty (TKA) is a successful and common procedure. However, 6–28% of patients are dissatisfied postoperatively. The provision of preoperative patient information, inquiring about patients’ expectations, and taking a psychiatric history are essential parts of both preoperative evaluation and postoperative outcome. The aim of this study was to investigate how orthopaedic knee surgeons in Sweden inform their patients before surgery.

A questionnaire was distributed to all knee surgeons performing TKA in Sweden. Responses were received from 60 of the 65 orthopaedic departments performing TKA in Sweden (92%), covering 219 of the approximately 311 knee surgeons at the 65 departments (70%). The answers were analysed with descriptive statistics. A content analysis of the surgeons’ opinions was also performed using a thematic method.

In terms of information provision, 58% of the surgeons always gave written information while 92% informed orally. Only 44% always asked about the patient’s expectations, and only 42% always informed patients about the 20% dissatisfaction rate after TKA. Additionally, 24% never operated on mild indication of arthrosis, 20% always took a psychiatric history, and half never or seldom consulted a psychiatrist. However, all the knee surgeons believed in a psychiatric impact on TKA outcome. Qualitative analysis revealed five common causes of patient dissatisfaction, which in descending frequency were: patients’ expectations, choice of patients to operate on, surgical factors, combinations of factors, and insufficient information provision to patients.

Knee surgeons in Sweden have considerable awareness of the importance of preoperative patient information, the impact of patient expectations, and psychiatric illness. However, they need to improve their preoperative routines when it comes to providing written information, asking about the patient’s expectations, and psychiatric assessment.

• Expectation
• Postoperative outcome
• Preoperative information
• Psychiatric history
• TKA

• Japanese Knee Osteoarthritis Measure
• Longitudinal evaluation
• Osteoarthritis
• Quality of life
• Total knee arthroplasty

• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Knee
• Female
• Follow-Up Studies
• Humans
• Knee Joint/surgery
• Longitudinal Studies
• Male
• Middle Aged
• Osteoarthritis, Knee/surgery
• Patient Satisfaction
• Quality of Life

• balanced gap technique
• gap balancing
• knee instability
• ligament balance
• soft-tissue balance
• total knee arthroplasty

• Knee range of motion
• knee replacement
• outcomes
• prognosis

• Algofunktion
• Arthroplastik
• Arthroplasty
• Pain and Functional Problems
• Psychosomatic Factors

• Knee arthroplasty
• Outcomes
• Patient expectations
• Patient satisfaction

• Community
• Health promotion
• Joint replacement
• Lower limb
• Physical activity

• Depression
• Pain
• Results
• Total knee arthroplasty

• Knee arthroplasty
• PROMS
• Satisfaction

It is not well understood why one in five patients report poor outcomes following knee arthroplasty. This study evaluated changes in knee biomechanics, and perceived pain among patients reporting either a good or a poor outcome in knee-related quality of life after total knee arthroplasty.

Twenty-eight patients (mean age 66 (SD 7) years) were included in this prospective study. Within one month of knee arthroplasty and one year after surgery, patients underwent three-dimensional (3D) gait analysis, completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), and rated perceived pain using a visual analogue scale. A “good outcome” was defined as a change greater than the minimally detectable change in the KOOS knee-related quality of life, and a “poor outcome” was defined as change below the minimally detectable change. Nineteen patients (68%) were classified as having a good outcome. Groups were analyzed separately and knee biomechanics were compared using a two-way repeated measures ANOVA. Differences in pain between groups were evaluated using Mann Whitney U test.

Patients classified as having a good outcome improved significantly in most knee gait biomechanical outcomes including increased knee flexion-extension range, reduced peak varus angle, increased peak flexion moment, and reduced peak valgus moment. The good outcome group also displayed a significant increase in walking speed, a reduction (normalization) of stance phase duration (% of gait cycle) and increased passive knee extension. Whereas, the only change in knee biomechanics, one year after surgery, for patients classified as having a poor outcome was a significant reduction in peak varus angle. No differences in pain postoperatively were found between groups.

Patients reporting a good outcome in knee-related quality of life improved in knee biomechanics during gait, while patients reporting a poor outcome, despite similar reduction in pain, remained unchanged in knee biomechanics one year after total knee arthroplasty. With regards to surgeon-controlled biomechanical factors, surgery may most successfully address frontal plane knee alignment. However, achieving a good outcome in patient-reported knee-related quality of life may be related to dynamic improvements in the sagittal plane.

• Biomechanics
• Function
• Gait
• Joint replacement
• Knee
• Osteoarthritis
• Quality of Life

• HAD
• KOOS
• TKA
• VAS pain
• dissatisfaction

Total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis. Patient-reported outcome after TKA is influenced by multiple patient-related factors. The aim of this study was to prospectively evaluate preoperative patient-related factors and to compare the self-reported outcomes 1 year after TKA among groups differing by age, sex, body mass index (BMI), education, and social support level.

314 patients, who underwent TKA in Vilnius Republican University Hospital between the end of 2012 and the middle of 2014, were included in a study. The preoperative and 12-month follow-up measurements were obtained using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-12 (SF-12). Differences between patient groups according to gender, age, BMI, level of education, and level of social support were analyzed.

At 12-month follow-up men demonstrated better results than women in WOMAC (P = .003) and SF-12 both domains (P < .05). Patients with a higher social support demonstrated higher scores in physical function according to SF-12 (P = .008). Better preoperative WOMAC and SF-12 scores were a predictor of better outcome 1 year after surgery. There was no difference in postoperative scores in different age, BMI, and education groups according to WOMAC and SF-12.

There is no difference in self-reported functional outcome between patient groups differing in age, BMI, and education. Men and socially supported patients demonstrate better postoperative functional results 12 months after TKA. Better preoperative knee function and overall physical and mental function are predictors of better outcome 1 year after TKA. Age and obesity should not be limiting factors when considering who should receive this surgery.

• BMI
• age
• arthroplasty
• knee
• sex

• Low back pain
• Osteoarthritis
• Patient-reported outcome
• Total knee arthroplasty

• Anterior knee pain
• Knee kinematics
• Retropatellar pressure
• Rotational malalignment
• Tibial component
• Total knee arthroplasty

• Chondrogenesis
• Economy
• Mesenchymal cell induced chondrogenesis
• Osteoarthritis
• Total knee arthroplasty

• Arthroplasty
• Decision-making
• Knee
• Osteoarthritis
• Therapeutics