Valgus approach to total knee arthroplasty
Since the first total condylar knee replacement in 1974 [1], standard total knee arthroplasty has been in development. With recent advances in surgical techniques, prosthetic designs, and evolution of instrumentation, standard total knee arthroplasties have demonstrated excellent long-term results with survival rates of 95% [1-5]. However, short-term results have often showed less favorable results. Standard total knee arthroplasty is a procedure that is frequently associated with a tremendous amount of pain and functional limits. Patients often require an intensive rehabilitation program with multiple hours of physical therapy per day for the first six weeks after these procedures. The functional outcomes and patient satisfaction after standard total knee arthroplasty may not be as optimal as what has been reported in the literature. Most studies have assessed the outcome after standard total knee arthroplasty utilizing objective criteria, such as the Knee Society clinical rating system and the Knee Society roentgenographic evaluation system. However, there is little information published considering subjective, patient-reported functional status or patient satisfaction after these procedures. The patient's judgment about the outcome of the procedure is equally important since the ultimate goal of this treatment option is pain relief and long-term satisfaction. Various studies have described a discrepancy between how surgeons perceive total knee arthroplasty and how patients assess their outcome. Bullens and colleagues [6] used a visual analog scale to assess satisfaction after total knee arthroplasty in a group of 108 patients (126 total knee arthroplasties) with short-term to medium- term follow-up. A comparison between subjective visual analog scale results and objective outcome measurement systems such as the Knee Society clinical rating system and Western Ontario and McMasters universities osteoarthritis index revealed only poor correlations. This comparison suggested that the criteria for satisfactory outcomes after total knee arthroplasty for patients and surgeons differ, and it appeared that surgeons are more satisfied than patients after the procedure. Dickstein et al. [7] studied the dissatisfaction rate of 79 patients by interviews and physical examinations after total knee arthroplasty 6 and 12 months postoperatively. They found that one third of the respondents expressed dissatisfaction from the operation. Robertsson and coworkers [8] reported on patient satisfaction after total knee arthroplasty in 27,372 knees registered in the Swedish joint registry. Stratified by underlying disease such as osteoarthritis or rheumatoid arthritis, there were 18% of the female patients (n=14,609) and 16% of male patients (n=6,556) with osteoarthritis unsatisfied or uncertain with the outcome of total knee arthroplasty, whereas, in the rheumatoid arthritis group the corresponding fractions were 14% (n=2,568) and 15% (n=635), respectively. The overall percentage of dissatisfied patients was 8%. Trousdale et al. [9] assessed patients concerns before undergoing total hip or total knee arthroplasty. The two greatest concerns were postoperative pain and length of recovery. Patient concerns and expectations must be addressed and balanced. © 2007 Springer Medizin Verlag Heidelberg.
