Patient satisfaction following medial unicompartmental knee arthroplasty at one year: a mixed methods study

PURPOSE: We aimed to (1) determine the frequency of dissatisfaction 1-year postoperatively in medial unicompartmental knee arthroplasty (mUKA) patients, (2) determine associations between preoperative factors and dissatisfaction, (3) gain insight into causes for dissatisfaction by performing interviews and supplementary questions of dissatisfied and satisfied patients more than 3 years postoperatively.

METHOD: In the first part of the study, data concerning 336 UKA patients from a prospective cohort study (SPARK) was analyzed. Using ordinal logistic regression, associations between baseline factors and patient satisfaction was investigated. In the second part, a qualitative study was conducted 3.4-years postoperatively: Matched satisfied and dissatisfied patients participated in interviews and completed questionnaires.

RESULTS: 298 patients responded 1 year post surgery. Dissatisfaction was more frequent in younger patients (p: 0.04), patients with lower Ahlbäck score (p: 0.0003) and when operated on by one specific surgeon (surgeon no. 8) (p: 0.01). 9 dissatisfied patients participated in interviews, as did 9 matched satisfied patients. Based on interviews, we found that patient dissatisfaction was related to (1) expectations to the knee arthroplasty, (2) information and communication, (3) follow-up and rehabilitation, (4) pain and discomfort. Dissatisfied patients recalled less participation in preoperative decision-making (p: 0.02) and that they did not feel adequately seen or heard (p: 0.01).

CONCLUSION: High rates of patient satisfaction were noted 1-year postoperatively. Among interviewed dissatisfied patients, 6 of 9 expressed other reasons than knee symptoms as the reason for dissatisfaction. This study points to factors related to the surgeon, age and severity of osteoarthritis as factors that may influence short-term mUKA results.

LEVEL OF EVIDENCE: II, prospective cohort study.