POS0272-HPR POOR RESPONSE TO TKA: THE PERSPECTIVE OF PATIENTS AND KNEE SPECIALISTS
Authors: M. Te Molder, J. Vriezekolk, J. M. H. Smolders, S. Van Onsem, P. Heesterbeek, C. Van den Ende
Journal: Annals of the Rheumatic Diseases (2021)

Background: Although most of the patients after total knee replacement (TKA) report very satisfied outcome scores, there is still a significant proportion of patients that experience persistent knee pain, functional disability or dissatisfaction after TKA because of osteoarthritis (OA). It is difficult to quantify the proportion of patients with poor response to TKA, as different definitions on failure are being used (1). Additionally, patients and surgeons only agree in 36% on failure of total joint replacement (TJR) (2). This may be caused by different perceptions about concepts underlying poor response to TKA. Objectives: To explore if patients and knee specialists have different views about relevant concepts reflecting poor response to primary TKA. Methods: A qualitative, multicentre study was performed using semi-structured interviews in Belgium and in the Netherlands. Purposive sampling was used to enrich data variation. Twenty-five patients with knee OA without surgical indications (N=2), pre- and postoperative patients (N=11 and N=12, respectively) and fifteen knee specialists (orthopedic surgeons (N=9), physician assistants (N=1), nurse practitioners (N=1) and specialized physiotherapists (N=4)) were interviewed individually. Conversations were audiotaped, transcribed verbatim, and analysed using a thematic analysis. Results: Concepts underlying poor response to TKA were: persistent pain, limited knee function, limitations in physical functioning, complications, unmet expectations, unexpected sequelae and dissatisfaction (Figure 1). The concepts persistent pain, limited knee functioning, complications and limited physical functioning were found to underly expectations and/or unexpected sequelae after TKA. Dissatisfaction was considered a overarching concept resulting from unmet expectations and/or unexpected sequelae after TKA (e.g. long-term use of pain medication, continuous awareness of the prosthesis). All seven concepts were identified by both patients and knee specialists although poor knee function was more often described by patients in terms of prosthesis awareness, whereas knee specialists described poor knee function in terms of instability. Conclusion: Patients and knee specialists identified similar concepts as relevant concepts reflecting poor response to TKA. These results will be used to formulate a uniform definition of poor response to TKA. References: [1]Te Molder MEM, Smolders JMH, Heesterbeek PJC, Van Den Ende CHM. Definitions of poor outcome after total knee arthroplasty: An inventory review. BMC Musculoskelet Disord. 2020;21(1):1–6. [2]Singh J, Mehta B, Mirza S, Figgie M, Sculco P, Parks M, et al. When has a knee or hip replacement failed? A patient perspective. J Rheumatol. 2019;47(9):1–18. Figure 1. Relevant concepts reflecting poor response to TKA according to the patients’ and knee specialists perspectives. Concepts in solid gray were relevant to both, prosthesis awareness was relevant to patients and instability was identified as important outcome by knee specialists. Disclosure of Interests: None declared