Total knee Arthroplasty: Patient expectations and outcomes in a resource constrained setting

Objective: Knee osteoarthritis significantly impacts the quality of life, particularly in advanced stages. Total knee arthroplasty (TKA) is a common treatment, but 20-30% of patients remain dissatisfied despite clinical improvements. This study evaluates TKA outcomes using patient-reported outcome measures (PROMs) in a low-middle-income country context. Methodology: A prospective cohort study from Aga Khan University Hospital of 70 patients with end-stage knee osteoarthritis undergoing TKA was conducted from May, 2023 to December, 2023, Improvement in Knee injury and Osteoarthritis Outcome Score (KOOS-42) at three months post-TKA was assessed. The secondary objectives were to evaluate the correlation between patient expectations and outcomes, a comparison of unilateral and bilateral TKA, and the effects of patellar resurfacing and home-based physiotherapy. Data were analyzed using Stata 17.0. Results: Significant improvements in KOOS scores were observed three months post-TKA (mean 71.0 ± 7.3, P<0.001) compared to preoperative scores (26.3 [21.6-30]). Patient expectations were higher than actual postoperative outcomes (P<0.001). The pre-operative functional score and Patellar resurfacing improved symptom scores (P=0.003), while other factors like unilateral vs. bilateral TKA and home-based physiotherapy showed no significant impact on overall KOOS scores. Conclusion: TKA significantly improves patient-reported outcomes, but a gap remains between expectations and actual outcomes. Tailored patient education is crucial to manage expectations and enhance satisfaction, especially in resource-limited settings. These findings support the need for patient-centered care approaches in TKA.