High Level of Residual Symptoms in Young Patients After Total Knee Arthroplasty

TLDR

Total knee arthroplasty is rapidly expanding, especially among younger patients. The study aimed to quantify residual symptoms and functional deficits in young TKA patients and advise surgeons to set realistic expectations. A national multicenter survey of 661 young patients, with satisfaction and function data collected by an independent third‑party center, was used to assess residual symptoms. Although 89 % were satisfied with daily activities and 91 % with pain relief, roughly one‑third reported residual symptoms—including pain, stiffness, noise, swelling, and difficulty with stairs—yet 50 % had returned to their preferred sports.

Abstract

TKA is among the fastest growing interventions in medicine, with procedure incidence increasing the most in younger patients. Global knee scores have a ceiling effect and do not capture the presence of difficulty or dissatisfaction with specific activities important to patients.We quantified the degree of residual symptoms and specific functional deficits in young patients who had undergone TKA.In a national multicenter study, we quantified the degree of residual symptoms and specific functional deficits in 661 young patients (mean age, 54 years; range, 19-60 years; 61% female) at 1 to 4 years after primary TKA. To eliminate observer bias, satisfaction and function data were collected by an independent, third-party survey center with expertise in administering medical outcomes questionnaires for federal agencies.Overall, 89% of patients were satisfied with their ability to perform normal daily living activities, and 91% were satisfied with their pain relief. After TKA, 66% of patients indicated their knees felt normal, 33% reported some degree of pain, 41% reported stiffness, 33% reported grinding/other noises, 33% reported swelling/tightness, 38% reported difficulty getting in and out of a car, 31% reported difficulty getting in and out of a chair, and 54% reported difficulty with stairs. After recovery, 47% reported complete absence of a limp and 50% had participated in their most preferred sport or recreational activity in the past 30 days.When interviewed by an independent third party, about 1/3 of young patients reported residual symptoms and limitations after modern TKA. We recommend informing patients considering surgery about the high likelihood of residual symptoms and limitations after contemporary TKA, even when performed by experienced surgeons in high-volume centers, and taking specific steps to set patients' expectations to a level that is likely to be met by the procedure as it now is performed.