Towards Understanding the Differences Between Satisfaction and Improvement After Unicondylar and Primary Total Knee Arthroplasty

AbstractBackground While satisfaction is often used by clinicians to assess outcomes after knee arthroplasty, the Centers for Medicare & Medicaid Services (CMS) has defined a 20-point increase in the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) at 1-year follow-up as their improvement metric representing a substantial clinical benefit (SCB). To better understand the differences between satisfaction and improvement, this study evaluated self-reported patient satisfaction, KOOS JR scores, and whether the CMS SCB was achieved at 1-year follow-up. Methods We identified 715 unicondylar knee arthroplasties (UKAs) and 1,836 primary total knee arthroplasties (TKAs) performed from October 2020 through August 2024 among patients who completed KOOS JR and PROMIS Global Health (GH) surveys at preoperative and 1-year follow-up intervals. These patients also responded to a binary yes/no question asking if they were satisfied with their knee arthroplasty at 1-year follow-up. The mean age at surgery was 68 years (range, 32 to 94), and 61% (1,556 of 2,551) were performed among women. Results At 1-year follow-up, 92% (656 of 715) of UKA and 91% (1,673 of 1,836) TKA patients reported they were satisfied (P = 0.61). The mean KOOS JR change was 25 (range, -21 to 100) for UKAs compared to 27 (range, -48 to 100) for TKAs (P = 0.01), 62% (441 of 715) of UKAs and 66% (1,216 of 1,836) of TKAs achieved the CMS SCB (P = 0.03). Multivariable analyses indicated that lower preoperative KOOS JR scores, being women, and higher preoperative GH Physical scores were associated with increased KOOS JR changes and an increased likelihood of achieving the CMS SCB. Conclusion Although UKA and TKA have similarly high rates of self-reported patient satisfaction, the frequency of patients achieving the CMS SCB can be considerably lower. Since 80% (718 of 894) of knee arthroplasty patients who did not achieve the CMS SCB were satisfied with their outcome, healthcare providers may want to discuss the difference between satisfaction and improvement when counseling their patients.