Quality of life after total knee arthroplasty

Authors: F. Canovas,L. Dagneaux (2018)

Link: https://doi.org/10.1016/j.otsr.2017.04.017

Background Information:

Total knee arthroplasty (TKA), or knee replacement surgery, is widely performed to relieve severe knee pain, improve function, and boost overall quality of life. While most patients report significant benefits, up to 30% remain dissatisfied—often because they feel their recovery doesn’t sufficiently meet their personal expectations. Researchers have realized that traditional outcome scores focusing on function may overlook broader factors—like mental health, social life, and psychological well-being—that heavily influence how patients perceive their recovery .

Purpose of the Study:

The goal of this review was to provide a comprehensive evaluation of how TKA affects quality of life and to identify the reasons some patients remain unhappy after surgery. The authors assessed a wide range of studies to determine how individual characteristics, surgical techniques, and post-operative care programs influence patient satisfaction. They also aimed to understand how realistic expectations—such as returning to work or sports—affect perceived success.

Methods and Data Analysis:

Canovas and Dagneaux did not conduct new experiments but systematically analyzed existing research, clinical data, and registry studies. They discussed how quality of life is measured using patient-reported outcome measures (PROMs), and they examined how various factors—such as patient physical condition, behavioral traits, surgical methods, and rehabilitation protocols—were linked to outcomes. They also reviewed how patient expectations for returning to work or sports shaped their satisfaction.

Key Findings and Conclusions:

The review confirms that most patients experience meaningful improvements in pain relief, mobility, and quality of life after TKA. However, up to 30% remain dissatisfied, and this dissatisfaction is strongly linked to unmet expectations across physical, social, and emotional domains. The authors stress that satisfaction is not determined solely by technical success; it's also shaped by psychological and lifestyle factors. Realistic goal-setting—especially regarding returning to work, sports, and community—is essential for better patient outcomes.

Applications & Limitations:

This review supports a more personalized approach to patient care. Clinicians should counsel patients early about realistic outcomes for weight, activity, and emotional recovery. Tailoring surgical techniques and rehabilitation to individual needs could enhance satisfaction. However, the analysis is limited by variability in study designs, a reliance on self-reported outcomes, and a lack of long-term, high-quality randomized trials. The review highlights the need for future research combining objective measures with patient expectations to improve satisfaction after TKA.