High level of residual symptoms in young patients after total knee arthroplasty.
BACKGROUND
TKA is among the fastest growing interventions in medicine, with procedure incidence increasing the most in younger patients. Global knee scores have a ceiling effect and do not capture the presence of difficulty or dissatisfaction with specific activities important to patients.


OBJECTIVE
We quantified the degree of residual symptoms and specific functional deficits in young patients who had undergone TKA.


METHODS
In a national multicenter study, we quantified the degree of residual symptoms and specific functional deficits in 661 young patients (mean age, 54 years; range, 19-60 years; 61% female) at 1 to 4 years after primary TKA. To eliminate observer bias, satisfaction and function data were collected by an independent, third-party survey center with expertise in administering medical outcomes questionnaires for federal agencies.


RESULTS
Overall, 89% of patients were satisfied with their ability to perform normal daily living activities, and 91% were satisfied with their pain relief. After TKA, 66% of patients indicated their knees felt normal, 33% reported some degree of pain, 41% reported stiffness, 33% reported grinding/other noises, 33% reported swelling/tightness, 38% reported difficulty getting in and out of a car, 31% reported difficulty getting in and out of a chair, and 54% reported difficulty with stairs. After recovery, 47% reported complete absence of a limp and 50% had participated in their most preferred sport or recreational activity in the past 30 days.


CONCLUSIONS
When interviewed by an independent third party, about 1/3 of young patients reported residual symptoms and limitations after modern TKA. We recommend informing patients considering surgery about the high likelihood of residual symptoms and limitations after contemporary TKA, even when performed by experienced surgeons in high-volume centers, and taking specific steps to set patients' expectations to a level that is likely to be met by the procedure as it now is performed.
The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA, research@rothmaninstitute.com.
Javad
J
Parvizi
Ryan M
RM
Nunley
Keith R
KR
Berend
Adolph V
AV
Lombardi
Erin L
EL
Ruh
John C
JC
Clohisy
William G
WG
Hamilton
Craig J
CJ
Della Valle
Robert L
RL
Barrack
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D010147:Pain Measurement; D017060:Patient Satisfaction; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D016896:Treatment Outcome