Aetiology of patient dissatisfaction following primary total knee arthroplasty in the era of robotic-assisted technology

Jonathan Gardner; Elliott R Roman; Rohat Bhimani; Sam J Mashni; John E Whitaker; Langan S Smith; Andrew Swiergosz; Arthur L Malkani

doi:10.1302/2633-1462.59.BJO-2024-0099.R1

Aetiology of patient dissatisfaction following primary total knee arthroplasty in the era of robotic-assisted technology

Bone Jt Open. 2024 Sep 12;5(9):758-765. doi: 10.1302/2633-1462.59.BJO-2024-0099.R1.

Authors

Jonathan Gardner¹, Elliott R Roman², Rohat Bhimani¹, Sam J Mashni², John E Whitaker¹, Langan S Smith³, Andrew Swiergosz¹, Arthur L Malkani⁴

Affiliations

¹ Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky, USA.
² University of Louisville School of Medicine, Louisville, Kentucky, USA.
³ UofL Health, ULP Orthopedics, Louisville, Kentucky, USA.
⁴ Adult Reconstruction Program, Dept. of Orthopedic Surgery, University of Louisville, Louisville, Kentucky, USA.

PMID: 39260450
PMCID: PMC11390183
DOI: 10.1302/2633-1462.59.BJO-2024-0099.R1

Abstract

Aims: Patient dissatisfaction following primary total knee arthroplasty (TKA) with manual jig-based instruments has been reported to be as high as 30%. Robotic-assisted total knee arthroplasty (RA-TKA) has been increasingly used in an effort to improve patient outcomes, however there is a paucity of literature examining patient satisfaction after RA-TKA. This study aims to identify the incidence of patients who were not satisfied following RA-TKA and to determine factors associated with higher levels of dissatisfaction.

Methods: This was a retrospective review of 674 patients who underwent primary TKA between October 2016 and September 2020 with a minimum two-year follow-up. A five-point Likert satisfaction score was used to place patients into two groups: Group A were those who were very dissatisfied, dissatisfied, or neutral (Likert score 1 to 3) and Group B were those who were satisfied or very satisfied (Likert score 4 to 5). Patient demographic data, as well as preoperative and postoperative patient-reported outcome measures, were compared between groups.

Results: Overall, 45 patients (6.7%) were in Group A and 629 (93.3%) were in Group B. Group A (vs Group B) had a higher proportion of male sex (p = 0.008), preoperative chronic opioid use (p < 0.001), preoperative psychotropic medication use (p = 0.01), prior anterior cruciate ligament (ACL) reconstruction (p < 0.001), and preoperative symptomatic lumbar spine disease (p = 0.004). Group A was also younger (p = 0.023). Multivariate analysis revealed preoperative opioid use (p = 0.012), prior ACL reconstruction (p = 0.038), male sex (p = 0.006), and preoperative psychotropic medication use (p = 0.001) as independent predictive factors of patient dissatisfaction.

Conclusion: The use of RA-TKA demonstrated a high rate of patient satisfaction (629 of 674, 93.3%). Demographics for patients not satisfied following RA-TKA included: male sex, chronic opioid use, chronic psychotropic medication use, and prior ACL reconstruction. Patients in these groups should be identified preoperatively and educated on realistic expectations given their comorbid conditions.