title: Does patient perception of alignment affect total knee arthroplasty outcome?
abstract: OBJECTIVE
  This study was designed to address a recurring observation in our centre that, despite a satisfactory postoperative radiographic limb alignment, some patients are dissatisfied with the alignment and appearance of their operated leg. We carried out a prospective survey to determine patient perception of limb alignment after total knee arthroplasty (TKA) and whether level of satisfaction with alignment affects clinical outcome.
  
  
  METHODS
  Patients self-rated their alignment, their satisfaction with alignment and their level of knee pain on a visual analogue scale (VAS). Additional outcome measures included pre- and postoperative Knee Society Score (KSS), Oxford Knee Score (OKS) and the Health Survey Short Form (SF-12).
  
  
  RESULTS
  Twenty of 87 (23%) patients were dissatisfied with their new leg alignment and had a poorer perception of pain and range of motion after TKA. Despite this finding, KSS and OKS were no different between patients who were satisfied and those who were dissatisfied with their limb alignment. The SF-12 showed a trend toward lower scores in patients who were dissatisfied with their limb alignment.
  
  
  CONCLUSIONS
  Satisfaction with perceived limb alignment appears to influence outcome after TKA and is not reflected in current outcome scales. Perhaps patients should be counselled on how alignment is restored and on what to expect of their limb alignment and appearance after TKA.
authors.affiliation: Hamilton Arthroplasty Group, Hamilton Health Sciences Henderson Hospital, affiliated with the Faculty of Health Sciences, McMaster University, Hamilton, Ont, Canada.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gandhi
authors.forename: Justin
authors.initials: J
authors.lastname: de Beer
authors.forename: Danielle
authors.initials: D
authors.lastname: Petruccelli
authors.forename: Mitchell
authors.initials: M
authors.lastname: Winemaker
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000502:physiology* / Q000601:surgery; D008297:Male; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D017060:Patient Satisfaction; D010465:Perception; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D011795:Surveys and Questionnaires