Patient satisfaction following TKA: Bless them all!

Survivorship following modern total knee arthroplasty (TKA) is good with revision rates generally lower than for total hip arthroplasty (THA). Our experience in Belfast supports that fact with original component survivorship of 99% for the low contact stress rotating platform TKA, which is better than our THA survivorship. It is important to discriminate between survivorship and patient satisfaction. In Belfast, as well as the more familiar outcome scores, we also use a very simple 4-point satisfaction questionnaire: "How would you best describe your satisfaction with your new joint" where 1=very happy, 2=happy, 3=OK but not perfect, and 4=I have never been happy. We applied this questionnaire to our 10-year THA and TKA patients. When we looked specifically at the numbers of patients who were either "very happy" or "never happy," the results were very different. The very happy percentage for hips was much higher than for knees (54% vs 4%) and conversely, the number of never happy knees was much higher than for hips (7% vs 1%). These results are not unique to Belfast. As surgeons, we often think that the knee implant that we use is the best but at present, the implant is no longer the most critical factor. We need to increase the number of very happy patients and decrease the number of never happy ones. In my opinion the two key factors that we should focus on are patient expectation and surgeon education.