Functional Outcomes and Patient-Reported Measures After Primary Total Knee Arthroplasty For Advanced Osteoarthritis: A Cross-Sectional Observational Study At A Tertiary Care Hospital

Abstract

Background: Advanced knee osteoarthritis is treated by total knee arthroplasty (TKA), which provides pain relief and function. Patient-reported outcomes (PROs) have emerged as a vital component of the assessment of TKA success but population-specific predictors of patient dissatisfaction have yet to be well described in the Indian context. This study compares functional outcomes, PROs and factors associated with dissatisfaction following primary TKA in a tertiary care center. Methods: One hundred adults who underwent unilateral primary cemented TKA for advanced primary knee OA (Kellgren-Lawrence ≥3) at a tertiary care hospital with 6–24 months’ follow-up were enrolled in this cross-sectional observational study. Outcome measures included Oxford Knee Score (OKS), Knee Society Score (KSS), WOMAC pain subscale, range of motion (ROM), and patient satisfaction (5-point Likert scale). Multivariable logistic regression identified predictors of dissatisfaction. Results: Mean OKS improved from 18 to 38 at 12 months (p<0.001); KSS-Knee from 42 to 86 (p<0.001); WOMAC pain subscale from 16 to 4 (p<0.001); ROM from 102° to 116° (p<0.001). Complication rates: SSI 3%, DVT 4%, per prosthetic infection 1%, stiffness requiring MUA 2%. Transfusion rate 14%. 86% patients were satisfied/very satisfied. Independent predictors of dissatisfaction: residual flexion <100° at 6 months (aOR 4.0), pre-operative depression (aOR 3.1), BMI ≥30 (aOR 2.2), and pre-operative flexion contracture ≥10° (aOR 2.0). Conclusion: Primary TKA achieves significant improvements in pain, function, and quality of life in the majority of patients. Pre-operative psychological optimisation, weight management, aggressive physiotherapy for post-operative ROM, and targeted patient expectation management are crucial to minimising dissatisfaction. Depression screening and rehabilitation should be incorporated into all TKA pre-operative assessment pathways.