What Matters Most for Patient Satisfaction Following Total Knee Arthroplasty? A Prospective Institutional Assessment of Individual Questions Captured by KOOS and VR-12 Mental Composite Score

Background Patient-reported outcome measures (PROMs) are crucial in evaluating the success of primary total knee arthroplasty (TKA). This study aimed to determine the individual significance of each question of the knee osteoarthritis outcome score (KOOS) and the Veterans RAND 12 (VR–12) mental composite score (MCS) in achieving a patient acceptable symptom state (PASS). Methods A prospectively collected cohort of 9,942 unilateral elective TKAs was analyzed. Responses were collected for 17 KOOS questions (KOOS-Pain sub score, KOOS-Physical Function Short form (PS), and KOOS-Joint related (JR)) and 6 MCS questions pre-operatively and 1-year post-operatively. Achievement of PASS was assessed through a positive response to a binary satisfaction-related question. The association between responses to questions and outcomes was examined via multivariable logistic regression models. Results A poorer preoperative response to knee pain frequency (OR= 0.86 [0.77–0.97], P= 0.017) and knee pain while sitting or lying (OR = 0.88 [0.79–0.99], P= 0.029) were independently associated with reduced odds of achieving PASS at 1-year post-TKA. A more favorable preoperative response in knee pain during full knee straightening was independently associated with an increased odds of PASS attainment (OR = 1.10 [1.01–1.19], P= 0.035). No other metric was independently associated with PASS attainment at one year. Conclusion Individual KOOS questions evaluating knee pain frequency, knee pain while sitting or lying down, and knee pain during full knee straightening were linked to patient satisfaction one-year following TKA. Patients experiencing frequent or persistent knee pain at rest may represent those with more advanced joint disease or heightened pain sensitivity, contributing to lower postoperative satisfaction. Conversely, patients reporting minimal or no pain during specific movements, such as full knee straightening, likely had a less severe baseline condition, making their postoperative expectations more easily attainable, thereby leading to higher satisfaction. Level of Evidence: III

Publication History

Received: 20 August 2024

Accepted after revision: 13 May 2025

Accepted Manuscript online:
14 May 2025