Single-item satisfaction scores mask large variations in pain, function and joint awareness in patients following total joint arthroplasty

Eur J Orthop Surg Traumatol. 2020 Feb;30(2):267-274. doi: 10.1007/s00590-019-02560-x. Epub 2019 Dec 9.


Introduction: Single-item questions assessing patient satisfaction following total hip or knee arthroplasty (THA/TKA) provide immediate and comprehensible information. However, they have limited reliability as satisfaction as a concept is influenced by factors unrelated to surgery. The aim of this retrospective study was to evaluate variation in pain, function and joint awareness relative to the patients' satisfaction response following THA/TKA.

Methods: We analysed absolute and improvement scores on the Oxford Knee or Hip score (OKS or OHS) and the Forgotten Joint Score-12 (FJS-12) across satisfaction groups. Patient-reported outcome measures were assessed prior to surgery and at 12-month follow-up. Postoperative satisfaction was assessed using a 5-point Likert scale single-item question.

Results: We analysed data from 434 TKA patients (mean age 70.4 ± 9.2 years; 54.8% female) and 247 THA patients (mean age 67.3 ± 11.8 years; 57.5% female). Satisfied or very satisfied patients showed higher absolute scores and better improvement in function, pain and joint awareness at 12 months (both, p < 0.001). 13.4% of (very) satisfied THA patients scored equally or worse on the FJS-12 than before surgery. On the OHS, this percentage was 2.8%. In TKAs, these percentages were 7.0% on the FJS-12 and 3.2% on the OKS.

Conclusions: While higher satisfaction is associated with better patient-reported outcomes and stronger postoperative improvement, a certain percentage of patients score poorly while reporting a high satisfaction. Our results highlight the difficulty in interpreting the meaning of a single satisfaction question, as this provides limited information on patients' treatment outcome and may be biased by factors unrelated to the intervention.

Keywords: Forgotten Joint Score-12; Oxford Knee and Hip Score; Patient-reported outcome; Satisfaction; Total hip arthroplasty; Total knee arthroplasty.

MeSH terms

  • Activities of Daily Living
  • Aged
  • Arthroplasty, Replacement, Hip* / adverse effects
  • Arthroplasty, Replacement, Hip* / psychology
  • Arthroplasty, Replacement, Hip* / statistics & numerical data
  • Arthroplasty, Replacement, Knee* / adverse effects
  • Arthroplasty, Replacement, Knee* / psychology
  • Arthroplasty, Replacement, Knee* / statistics & numerical data
  • Female
  • Humans
  • Male
  • Pain, Postoperative / epidemiology*
  • Pain, Postoperative / etiology
  • Patient Satisfaction / statistics & numerical data*
  • Recovery of Function*
  • Retrospective Studies