Article
Impairment driven patient expectations for TKA in a multicenter cross-sectoral study in Germany
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Authors
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Felix Wunderlich
- Universitätsmedizin Mainz, Zentrum für Orthopädie und Unfallchirurgie, Mainz, Germany
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Lukas Eckhard
- Universitätsmedizin Mainz, Zentrum für Orthopädie und Unfallchirurgie, Mainz, Germany
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Matthias Büttner
- Universitätsmedizin Mainz, IMBEI, Mainz, Germany
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Toni Lange
- Universitätsklinikum Carl Gustav Carus, TU Dresden, Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV, Dresden, Germany
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Ulrich Betz
- Universitätsmedizin Mainz, Institut für Physiotherapie, Prävention und Rehabilitation, Mainz, Germany
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Philipp Drees
- Universitätsmedizin Mainz, Zentrum für Orthopädie und Unfallchirurgie, Mainz, Germany
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Jörg Lützner
- Universitätsklinikum Carl Gustav Carus, TU Dresden, Centrum für Orthopädie, Unfall- & Plastische Chirurgie, Dresden, Germany
| Published: | October 26, 2021 |
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Outline
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Objectives: Post-operative outcome after Total Knee Arthroplasty (TKA) in the treatment of end stage osteoarthritis (OA) correlates strongly with pre-operative impairment-driven patient treatment goals. However, a clinical tool for measuring patient treatment goals in correlation to impairments is still missing, which impedes patient-oriented indication in TKA.
Methods: Patients scheduled for TKA were recruited in four German hospitals. All patients were handed a newly developed questionnaire pre-operatively, containing 31 treatment goals with coherent impairments in seven categories, and were asked to rank all treatment goals and coherent impairment on a 3-point-Likert scale. Treatment goals and impairments were then checked for frequency of occurrence and correlation of goal and respective impairment was tested using Spearman's rank correlation. Univariate analysis was conducted for analyzing associations of treatment goals and different cohort-characteristics (e.g. age, gender, Body Mass Index (BMI)).
Results: 1.298 patients with complete data set were included in the study.
Most frequently chosen "severe impairments" were: "knee pain", "limitation in physical function", "walking distance", "climbing stairs", "physical activity", "sports" and "long standing".
Most frequently chosen "main treatment goals" were: "knee pain", "range of motion", "walking distance", "overall physical function", "climbing stairs", "quality of life" and "implant survival". Very strong correlation (>.80) was shown for the category "sex life", whereas no category showed a very weak correlation (<.19) (Table 1 [Tab. 1]). There were several significant correlations between treatment goals regarding gender and different age and BMI groups.
Conclusion: Overall correlations between impairments and patient treatment goals were high. Significant differences in importance and frequency of treatment goals in different patient groups were shown when stratified by age, gender or BMI. On behalf of these outcomes we suggest, physicians should clearly assess their patients' demands and characteristics prior to TKA to maximize post-operative outcome.
