PREDICTIVE FACTORS FOR OUTCOMES AND PATIENT SATISFACTION 2-YEARS AFTER TOTAL KNEE ARTHROPLASTY
DOI:
https://doi.org/10.22159/ajpcr.2025v18i4.53961Keywords:
Knee arthroplasty, patient satisfaction, Oxford knee score, Knee society knee score, Knee society functional scoreAbstract
Objectives: There is a lack of strong correlation between functional outcomes and patient satisfaction following total knee arthroplasty (TKA). This study evaluated whether the change in these scores from pre- to post-operative periods predicted patient satisfaction 2 years after TKA.
Methods: We evaluated data from 374 TKAs, assessing knee society score, Oxford knee score (OKS), and Short-Form 36 (SF-36) scores. A satisfaction questionnaire was completed, and logistic regression was performed. Receiver operating characteristic (ROC) curves assessed each scoring system’s ability to predict satisfaction at 2 years.
Results: The ROC curve analysis between the physical component of SF-36 and the mean difference in pre-operative and post-operative scores showed that the area under the curve (AUC) was highest for the OKS (0.837, 95% confidence interval [CI]=0.708–0.967). The cutoff value was 12.5. At this threshold, the sensitivity and specificity of the OKS in predicting patient satisfaction were 80% and 77%, respectively. The AUC for Knee society knee score (KSKS) was 0.782 (95% CI=0.649–0.916). The cutoff value for the KSKS difference was 50.5. At this threshold, the sensitivity and specificity of KSKS for predicting patient satisfaction were 77.8% and 83%, respectively. The AUC for Knee society function score (KSFS) was 0.733 (95% CI=0.590–0.877). The cutoff value for the KSFS difference was 22.5. At this threshold, the sensitivity and specificity of KSKS for predicting patient satisfaction were 77.8% and 58.3%, respectively.
Conclusion: The pre- to post-operative change in OKS more accurately predicts patient satisfaction at 2 years than KSKS (cut-off value: 50.5) and KSFS (cut-off value: 22.5), respectively.
Downloads
References
Vaidya SV, Jogani AD, Pachore JA, Armstrong R, Vaidya CS. India joining the world of hip and knee registries: Present status-a leap forward. Indian J Orthop. 2020;55(Suppl 1):46-55.
Patel V, Deshpande SV, Jadawala VH, Bhalsod D, Sawant S. Evaluating short-term patient-reported outcome measures following total hip and knee replacement: A comprehensive review. Cureus. 2024;16:e70468.
Goh GS, Liow MH, Bin Abd Razak HR, Tay DK, Lo NN, Yeo SJ. Patient-reported outcomes, quality of life, and satisfaction rates in young patients aged 50 years or younger after total knee arthroplasty. J Arthroplasty. 2017;32:419-25.
Bergstein VE, Weinblatt AI, Taylor WL 4th, Long WJ. Total knee arthroplasty survivorship and outcomes in young patients: A review of the literature and 40-year update to a longitudinal study. Arch Orthop Trauma Surg. 2024;144:4077-83.
Weldring T, Smith SM. Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs). Health Serv Insights. 2013;6:61-8.
Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg 2004;86:963-74.
Janse AJ, Gemke RJ, Uiterwaal CS, Van Der Tweel I, Kimpen JL, Sinnema G. Quality of life: Patients and doctors don’t always agree: A meta-analysis. J Clin Epidemiol. 2004;57:653-61.
Batailler C, Lording T, De Massari D, Witvoet-Braam S, Bini S, Lustig S. Predictive models for clinical outcomes in total knee arthroplasty: A systematic analysis. Arthroplast Today. 2021;9:1-15.
Castro-Dominguez F, Tibesku C, McAlindon T, Freitas R, Ivanavicius S, Kandaswamy P, et al. Literature review to understand the burden and current non-surgical management of moderate-severe pain associated with knee osteoarthritis. Rheumatol Ther. 2024;11:1457-99.
Goh GS, Liow MH, Pang HN, Tay DK, Lo NN, Yeo SJ. Patients with poor baseline mental health undergoing unicompartmental knee arthroplasty have poorer outcomes. J Arthroplasty. 2018;33:2428-34.
Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998 Jan;80(1):63-9.
Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the knee society clinical rating system. Clin Orthop Relat Res. 1989;248:13-4.
Ware JE Jr., Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: Summary of results from the medical outcomes study. Med Care. 1995;33:AS264-79.
Escobar A, Gonzalez M, Quintana JM, Vrotsou K, Bilbao A, Herrera- Espiñeira C, et al. Patient acceptable symptom state and OMERACT-OARSI set of responder criteria in joint replacement. Identification of cut-off values. Osteoarthritis Cartilage. 2012;20(2):87-92.
Callahan CM, Drake BG, Heck DA, Dittus RS. Patient outcomes following tricompartmental total knee replacement. A meta-analysis. JAMA. 1994;271(17):1349-57. PMID:8158821.
McCalden RW, Robert CE, Howard JL, Naudie DD, McAuley JP, MacDonald SJ. Comparison of outcomes and survivorship between patients of different age groups. J Arthroplasty. 2013;8 Suppl:83-6.
Jiang L, Bin Abd Razak HR, Chong HC, Tan A. Preoperative patient characteristics and outcomes of total knee arthroplasty in a multiethnic Asian population stratified by ethnicity. J Arthroplasty. 2014;29(2):304-7.
D’Apuzzo MR, Novicoff WM, Browne JA. The john insall award: Morbid obesity independently impacts complications, mortality, and resource use after TKA. Clin Orthop Relat Res. 2015;473(1):57-63.
Dorr LD, Chao L. The emotional state of the patient after total hip and knee arthroplasty. Clin Orthop Relat Res. 2007;463:7-12.
Goh GS, Bin Abd Razak HR, Tay DK, Lo NN, Yeo SJ. Early post-operative Oxford knee score and knee society score predict patient satisfaction 2 years after total knee arthroplasty. Arch Orthop Trauma Surg. 2021;141(1):129-37.
Clement ND, Macdonald D, Burnett R. Predicting patient satisfaction using the Oxford knee score: Where do we draw the line? Arch Orthop Trauma Surg. 2013;133(5):689-94.
Kwon SK, Kang YG, Kim SJ, Chang CB, Seong SC, Kim TK. Correlations between commonly used clinical outcome scales and patient satisfaction after total knee arthroplasty. J Arthroplasty. 2010;25(7):1125-30.
Baker PN, Van Der Meulen JH, Lewsey J, Gregg PJ, National Joint Registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the national joint registry for England and wales. J Bone Joint Surg Br. 2007;89(7):893-900.
Published
How to Cite
Issue
Section
Copyright (c) 2025 Mayank Daral, Rishabh Gupta, Vasu Sharma, Rahul Bhargava

This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.