PURPOSE A proportion of TKA recipients following TKA are dissatisfied with their outcome. Our hypothesis is that patient satisfaction with TKA and perception of success of surgery are associated with patient comorbidities and overall health status, surgical and anaesthetic techniques as well as processes of post-operative care after TKA. The aims were to (i) measure the incidence of patient unfavourable outcomes-defined as dissatisfaction with the surgery or lack of joint-specific global improvement-1 year after TKA, and to explore the differences between these two outcomes of interest; (ii) assess the relationship between the development of these unfavourable outcomes and patient-reported knee function and overall quality of life; (iii) explore the associations between pre- and peri-operative variables and the development of these unfavourable outcomes 1 year after TKA. METHODS This study includes analysis of data from a prospective cohort of 1017 TKA recipients. Pre-operative patient variables, surgical and acute-care data were collected. The Oxford knee score and the global perception of improvement were used to assess satisfaction and success 365 days post-surgery. RESULTS From 1017 patients (56% female), mean age 68 years and BMI 32, 68 pts (7%) were dissatisfied with the outcome of surgery, 141 pts (14%) believed surgery was unsuccessful 1 year after TKA. A negative outcome was noted in 151 (15%) patients for either satisfaction or success, and 58 (6%) of patients reported neither good satisfaction nor success after surgery. Dissatisfied patients reported worse mean OKS (26.4 [SD 8.03] vs 42.3 [SD 5.21], p < 0.001) and mean EQ VAS (64.9 [SD 19.49] vs 81.8 [SD 14.38], p < 0.001) than satisfied patients. Patients who reported unsuccessful surgery also showed significantly lower mean OKS (30.9 [SD 9.29] vs 42.9 [SD 4.39], p < 0.001) and mean EQ VAS (68.2 [SD 18.61] vs 82.7 [SD 13.77], p < 0.001). Univariate analysis of predictors of unfavourable outcome post-TKA showed that financial status, obstructive sleep apnoea (OSA), ASA class > 2 and not resurfacing the patella were factors associated with the development of dissatisfaction with TKA and with patient perceived unsuccessful results of TKA. Multivariable logistic regression of patient satisfaction and success of TKA showed that compensation cases (OR 26.91, p < 0.001 for dissatisfaction and OR 11.49, p = 0.001 for unsuccessful TKA), obstructive sleep apnoea (OR 2.18, p = 0.04 for dissatisfaction and OR 1.82, p = 0.04 for unsuccessful TKA), ASA grade > 2 (OR 1.83, p = 0.04 for dissatisfaction and OR 1.57, p = 0.03 for unsuccessful TKA)and the development of a complication after TKA (OR 3.4, p < 0.001 for dissatisfaction and OR 2.39, p < 0.001 for unsuccessful TKA) were associated with the development of a negative outcome in both groups. Patella preservation (OR 1.96, p = 0.03) was associated with dissatisfaction, whereas the use of cruciate retaining femoral prosthesis was associated with less successful results of TKA (OR 1.78, p = 0.009). CONCLUSIONS An unfavourable outcome occurs in approximately 7-15% of patients following TKA. The incidence varies with how an unfavourable result is defined and many factors are associated with this outcome though prosthetic design or patella resurfacing do not appear to be important.

中文翻译：

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与手术或麻醉因素相比，全膝关节置换术后的患者满意度和成功感与患者因素和并发症的相关性更高。

目的接受TKA的TKA接受者中有一部分对他们的结果不满意。我们的假设是，患者对TKA的满意度和对手术成功的看法与患者合并症和总体健康状况，手术和麻醉技术以及TKA术后的护理过程有关。目的是（i）测量患者不良结局的发生率，定义为对TKA手术后1年不满意手术或缺乏关节特异性整体改善，并探讨这两种感兴趣的结局之间的差异；（ii）评估这些不良结局的发展与患者报告的膝盖功能与整体生活质量之间的关系；（iii）探讨术前和围手术期变量与TKA一年后这些不良结局的发展之间的关系。方法该研究包括对来自1017名TKA接受者的预期队列的数据进行分析。收集术前患者变量，手术和急性护理数据。牛津膝关节评分和对改善的整体看法被用来评估术后365天的满意度和成功率。结果在1017例患者（56％的女性）中，平均年龄68岁且BMI 32的患者对手术结局不满意，有68例（7％），其中141例（14％）认为TKA术后1年未成功。151名（15％）患者的满意或成功结果为阴性，而58名（6％）的患者在手术后既没有满意也没有成功。不满意的患者报告平均OKS（26.4 [SD 8.03]比42.3 [SD 5.21]，p <0.001）和平均EQ VAS（64.9 [SD 19.49] vs 81.8 [SD 14.38]，p <0.001）差。报告手术失败的患者还显示平均OKS显着降低（30.9 [SD 9.29] vs 42.9 [SD 4.39]，p <0.001）和平均EQ VAS（68.2 [SD 18.61] vs 82.7 [SD 13.77]，p <0.001）。对TKA后不良结局的预测因素的单因素分析表明，财务状况，阻塞性睡眠呼吸暂停（OSA），ASA 2级以上且未re骨消失是与TKA不满意发展以及患者认为TKA结果不成功相关的因素。患者满意度和TKA成功率的多变量logistic回归表明，补偿案例（OR 26.91，p <0.001表示不满和OR 11。49，tKA失败者p = 0.001），阻塞性睡眠呼吸暂停（OR 2.18，对不满意者p = 0.04和OR 1.82，对tka不成功者p = 0.04），ASA等级> 2（对于不满意者OR 1.83，p = 0.04和OR 1.57 ，对于不成功的TKA，p = 0.03）和TKA术后并发症的发生（OR 3.4，对于不满意的p <0.001和OR 2.39，对于不成功的TKA的p <0.001）与两组阴性结果的发生有关。preservation骨保存（OR 1.96，p = 0.03）与不满意相关，而使用十字形保留股骨假体与TKA的成功率较低（OR 1.78，p = 0.009）相关。结论TKA后约7-15％的患者发生不良预后。