الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
SUMMARY
In advanced painful osteoarthritis of the knee, the last resort is total knee arthroplasty (TKA). TKA is a very successful form of treatment for degenerative osteoarthiritis of the knee. The demand for TKA is growing around the world because of the aging population and the need to preserve people’s quality of life. However, one in every 300 knee arthroplasties, pain without any known explanation will be present. The pain may occur either at rest or with movement. The knee may have a good range of motion, and objective evaluation of the prosthesis may show a perfect result, with good positioning of the implants seen on radiographs, yet the patient complains of pain. Adequate assessment of this condition is important for orthopedists who carry out TKA.
Satisfaction with TKA is primarily determined by patients` expectations, and not their absolute level of function. Real improvements in the outcome of TKA must address prevention of residual pain, stiffness and swelling, and each patient`s postoperative concept of the likely outcome of these procedures.
Several functional disabilities were related with patient dissatisfaction. The top five severe functional disabilities were difficulties in kneeling, squatting, sitting with legs crossed, sexual activity, and recreational activities. The top five in order of perceived importance were difficulties in walking, using a bathtub, working, recreation activites, and climbing stairs. Severities of functional disabilities were not found to be correlated with perceived importance.
Postoperative pain can be associated with the preoperative diagnosis, such as rheumatoid arthritis, and patient`s mental status, such as anxiety and depression, whereas functional recovery may be affected by age and gender.
External components that can be associated with patient satisfaction include anesthesia, postoperative pain management, surgical technique, implant type, and postoperative rehabilitation.
The preoperative psychological state of a patient may determine patient satisfaction following TKA. Preoperative psychological factors of patients such as anxiety, depression, catastrophizing state, poor self-efficacy, and poor coping skills may be preoperative predictors of unsatisfactory patient outcomes after TKA.
This study identified the causes and predictors of patient`s dissatisfaction after complicated TKA (eg., component malalignment, postoperative early/late infection, patellar tendon rupture,…etc), factors of residual pain during activities of daily living and/or at rest, relation of pain and function in determining dissatisfaction and improvement of TKA outcome measures.
TKA is an effective intervention for many recipients, with major gains in health-related quality of life reported by those who receive the procedure. Although, most patients report high levels of satisfaction post-surgery; we revealed that rate of dissatisfaction is 14% with 95% CI of rate 97.63 to 98.37 with absence of publication bias.
CONCLUSION AND RECOMMENDATIONS
This research aimed to clarify the reasons for patients’ satisfaction and dissatisfaction after primary total knee replacement surgery. To conclude, There is a percentage of dissatisfaction among patients ranging from 8-25%, with a prevalence of 14-15 % in most studies.
Further, it turns out that the reasons for dissatisfaction are many, some of them are internal and others are external, for example residual pain and limited function, but also mental and psychological health was detected as one of important determinants of patient satisfaction following TKA.
The level of self-reported mental health and changes in that level over time predict satisfaction rates. This important finding points to the need for broad clinical review of patients, before and after surgery that encompasses both physical and mental health aspects, especially if there are questionnaire to detect the mental / psychological status of surgical candidate.
Satisfaction after total knee arthroplasty is a complex problem with many intertwining factors. Although the participants shared common wishes and needs after surgery, they had their own expectations and points of view regarding factors that can lead to the success of surgery. These factors need to be explored and addressed with each individual patient. The elements of unfulfilled expectations need to be dealt with both on the level of individual staff and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient contentment after TKA surgery. Furthermore, the importance of both preoperative and postoperative patient education should be an area to focus on in future studies, in order to improve patient satisfaction. Patient satisfaction is a process that starts with the first contact before surgery and continues until the patient decides it is complete.
There is a need to consider new interventions to promote mental health and wellness amongst patients receiving TKA but this should, of course, be subjected to evaluation of its costs and benefits before implementation. Further research is needed to quantitatively analyze the discontentment factors that emerged from this study.