Knee replacement for osteoarthritis: facts, hopes, and fears.
Osteoarthritis (OA) affects hundreds ofmillions of people worldwide and
is responsible for a huge burden of pain, functional limitations, and
loss of quality-adjusted life expectancy. OA of the knee accounts for
more than 90% of total knee replacements (TKR). By 2030, the incidence of
TKR in the US is expected to increase by more than 6-fold. Pain and difficulty
walking limiting participation in daily activities are the primary reasons for undergoing
TKR. However, among patients with disabling OA, only aminority are
willing to consider TKR. Reduced willingness to undergo TKR is associated
with increasing age, being black (in the US), overestimation of the pain and
disability needed to warrant TKR, and rejection of the medicalization of OA.
The perception of the benefits of TKR is less positive among women and those
of lower socioeconomic status. TKR is one of the most cost-effective medical
interventions. Data from joint registries show that the 10-year reoperation rate
for TKR is less than 5%. However, between 10% and 30% of patients undergoing
TKR report little or no improvement following surgery, or are not satisfied.
Patients’ expectations of joint replacement are relief of pain and improved
mobility. Following TKR, the expectations regarding pain relief, walking ability,
and the ability to perform daily activities are fulfilled to a greater extent
than the expectations of being able to performmore physically demanding activities.
To ensure optimal patient satisfaction, health professionals should
provide sufficient information so that patients have realistic expectations of
the results of TKR.