The negatives of knee replacement surgery: complications and the dissatisfied patient

摘要

Total knee replacement (TKR) surgery is a very effective treatment option for patients with disabling and severe end-stage knee pain. It is usually life-changing surgery and most patients report improvements in outcome measures scoring pain, function and quality of life. However, around 14—53 of TKR patients have some level of persisting knee pain, 7—50 of TKR patients report poor knee function, and mean published dissatisfaction rates range between 15 and 30. This article reviews the negatives of knee replacement surgery, covering the risks of potential complications and the factors that should routinely be discussed in detail with patients as part of the informed consent process. Knee osteoarthritis is a common and disabling condition, and around 10 of men and 13 of women over the age of 60 are believed to suffer regular symptoms. Total knee replacement (TKR) surgery is a very effective treatment option for patients with disabling and severe end-stage knee pain resulting from osteoarthritis, post-traumatic arthritis and inflammatory arthritis. It is usually life-changing surgery and most patients report improvements in outcome measures scoring pain, function and quality of life. There are nearly 100 000 primary TKRs implanted per year in England and Wales, and numbers are expected to double over the next 15 years due to an ageing, heavier and more active population. The proportion of younger patients undergoing TKR surgery is also expected to increase for the same reasons. As the title of this article suggests, all is not completely rosy. Despite the majority (71) of TKR patients perceiving an improvement in their knee symptoms,3 the literature suggests that 14 —53 of TKR patients have persisting knee pain and 7—50 have poor knee function,4 with mean, published dissatisfaction rates ranging anywhere from 15 to 30,5'6 and with only 22 of patients rating their results as "excellent".