Patients’ Satisfaction About Total Knee Replacement Surgery in Saudi Arabia

Total knee arthroplasty (TKA), also known as total knee replacement (TKR), is an elective joint surgical management and became a common procedure worldwide [1]. With its high success rates, the numbers of TKA among older adult patients increased, especially in the Middle Eastern region [2]. The primary advantage of this procedure is alleviating joint pain and improving mobility for patients suffering from advanced-stage osteoarthritis [3]. Fortunately, more recent articles suggested that just 4% to 7% of patients were dissatisfied with the results of their total knee replacement [4].

An increasing number of total knee arthroplasty (TKA) treatments performed in the United States exceeded 700,000 in 2012, with expected growth of up to 3.5 million procedures completed by 2030 [5]. A prospective cohort study published in 2019 on patient satisfaction with primary total knee replacement in Sulaimani City reported that 71.7% of the patients were satisfied [3]. In 2022, a cross-sectional study was conducted on patient satisfaction and quality of life in Saudi Arabia toward total knee replacement and total hip replacement surgeries, showing a high satisfaction rate for joint replacement surgeries [6]. In 2020, a retrospective cohort study was published on the correlation between radiographic severity of arthritis and patient satisfaction toward total knee replacement, showing patients with severe arthritis had an overall satisfaction rate of 96% compared with 82% in mild arthritis [7].

Undoubtedly, TKR represented one of the most frequent orthopedic procedures globally and proportionally grew over time due to the apparent increase in the underlying risk factors [8]. Notably, primary TKA cases were projected to climb to 85% by 2030 [9]. By the end of 2030, 3.48 million TKR procedures were anticipated to have been performed worldwide [10]. Accordingly, given the growing number of knee replacements and the associated collateral effects, measuring how satisfied targeted people are and understanding potential TKA outcomes become increasingly important [11]. Thus, this study was primarily conducted to assess the level of satisfaction with TKA in Saudi Arabia. Our study aimed to evaluate patient satisfaction with TKA in Saudi Arabia and determine how it affects their daily life activities. We also aimed to identify preoperative and postoperative predictors of patient satisfaction after TKA.

Objectives

The objectives of this research were to establish quantitative data regarding the satisfaction level and quality of life post-TKA among the population in Saudi Arabia, determine the impact of TKA among people in Saudi Arabia, and identify potential predictors of patient satisfaction and QoL in the preoperative and postoperative phases of TKA.

Study Design

A cross-sectional study was conducted among the population of Saudi Arabia. The study involved a questionnaire that was filled out by researchers and data collectors.

Study Population

This study included adult male and female patients who underwent TKA in Saudi Arabia.

Recruitment

Individuals from the general population were invited to participate in the study voluntarily. Patient data were collected through structured interviews.

Sampling Procedure

A conventional sampling technique was employed.

Inclusion and Exclusion Criteria

Inclusion criteria

Patients of all age groups and both genders underwent TKA (citizen and resident populations in Saudi Arabia).

Exclusion criteria

All orthopedic arthroplasty procedures excluding TKR.

Sample Size

Using the Qualtrics calculator with a 95% degree of confidence, the estimated minimum sample size was determined to be 384. The formula used to calculate the sample size was:

n=P(1−P)∗Zα2/d2n = P(1−P) * Zα² / d²

Method for Data Collection and Instruments (Data Collection Technique and Tools)

Researchers and data collectors were deployed in four main regions: the Northern, Southern, Eastern, and Western regions. We interviewed the patients who had undergone TKA in clinics. We then reached out to them, and administered the Arabic version of the questionnaire. The questions were presented in the local language to ensure honest responses. The survey was divided into three parts, adapted from previous research [6]. The first part covered demographic information such as age, BMI, and education level. The second part included five questions focused on patient satisfaction. Lastly, the third part was the widely recognized SF-12 questionnaire, a validated standard for measuring quality of life.

Scoring System

The second section consisted of five questions, with a total of eight possible points (Yes = 1, No = 0, Very highly = 4, Highly satisfied = 3, Moderately = 2, Minimally = 1, Not satisfied at all = 0).0–4 = Not satisfied, 5 = Moderately satisfied and 6–8 = Highly satisfied. The scoring of the third section followed Ware and his colleagues’ methodology [12].

Analysis and Entry Method

Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 25 for Windows (Chicago, IL, USA). Mean and standard deviation for quantitative variables and counts (%) for qualitative variables were used to summarize the data, with a level of significance set at p ≤ 0.05.

Table 1 displays various demographic parameters of the participants with a total number of 228. Participants' mean age stands at 57.9 years while 29.4% of participants are 54 years old or younger, indicating that middle-aged individuals form the majority who show relevance to chronic illness-related factors. The research sample reveals that females who join studies outnumber males 59.2% to 40.8% due to potential industry practices that tend to draw a primarily female participant base. Survey findings indicate that marriage exists among a greater portion of 67.1% of respondents relative to other marital statuses because social networks are likely to support their health outcomes after knee joint surgery. The study shows high numbers of persistent medical conditions with diabetes mellitus 42.9% followed by hypertension 37.7% while most patients received one knee joint replacement procedure 87.3%. The study population consists mainly of educated participants since 35.1% of them hold a bachelor's degree which enables researchers to perform detailed examinations of how education impacts health literacy and treatment compliance.

Table 1: Sociodemographic Characteristics of Participants (N=228)

*Results may overlap

As shown in Figure 1, Information and indicators of success in overall joint replacement treatments emerge from the data presented in the figure. A substantial 88.1% of the respondents scored their joint replacement outcomes highly positive with "very highly satisfied" (76 respondents) and "highly satisfied" (106 respondents). Overall these two categories represent 36.6% and 51.5% of all respondents. A combined total of 88.1% of participants stood content with their results from joint replacements. The survey results showed that 16.8% of participants selected "moderately satisfied" and "minimally satisfied" and "not satisfied at all" received responses from 35 (16.8%) 8 (3.9%) and 3 (1.5%) respectively. Two out of every ten patients reported being dissatisfied with their joint replacement surgery but the large majority of 88.1% expressed satisfaction demonstrating a positive attitude toward this surgical intervention.

Figure 1: Illustrates Satisfaction with Joint Replacement among Participants

Table 2 shows that surgical outcomes proved effective at enhancing life quality based on the 79.8% of patients who expressed "very highly satisfied" and "highly satisfied" satisfaction levels. The surgical intervention received support from patients who indicated their intention to repeat the same procedure because they trusted the treatment. The study results reveal major functional improvements because surgery helped people improve their physical capabilities 86.4% and almost all subjects 94.7% noticed decreased pain post-treatment. The patient population showed strong approval of total knee replacement surgery by recommending it at an 88.6% rate which demonstrates that this procedure meets their needs successfully.

Table 2: Parameters Related to Satisfaction with Total Knee Surgery Replacement (N=228)

As shown in Figure 2, Most members of the surveyed population express positive views about their health according to the data shown in the figure. The "Excellent" health rating was received by 80 subjects made up 39% of the total respondents while "Very Good" was earned by 81 individuals which amounted to 39.5% of participants. The substantial numbers grap a real picture of how well this demographic feels about their health. The respondents categorizing their health as "Good" made up 22% of the study participants indicating a possible opportunity to improve their health condition. The assessment of "Fair" health status and "Poor" health status was reported by 8% of participants at 16 people and 3% with six individuals respectively.

Figure 2: Illustrates Health Status Among Participants

The data in Table 3 demonstrates valuable findings about patient life quality after total knee replacement treatments which examined 228 surgical patients. A substantial number of respondents described their health conditions positively because 70.6% rated their health "Excellent" or "Very Good." The outcome demonstrates surgical success since the procedure effectively produces improved total patient welfare. Most patients (72.8%) experienced no limitations in doing moderate activities while 57.5% showed no restrictions in climbing staircases multiple times illustrating the successful role of surgical intervention in restoring functional mobility. Some patients faced limitations to their daily activities because of emotional problems although this only occurred in a significant minority according to survey results (13.6%). The research indicates that 55.7% of participants faced no daily task challenges due to pain but ongoing pain management solutions might benefit the few people who faced any level of interference.

Table 3: Participants’ Quality of Life After Total Knee Surgery Replacement (N=228)

Table 4 within the research article shows findings about total knee replacement surgery patient satisfaction which provides essential understanding of postoperative experience for studied subjects. The surgical intervention demonstrated effectiveness through patient satisfaction results because 84.2% of participants expressed high satisfaction rates. A minority set of patients made up 7.9% of those who described their satisfaction as moderate while an exact same percentage rated it as low.

Table 4: Shows Satisfaction with Total Knee Replacement Surgery Score Results

The research article uses Table 5 to deliver powerful findings about patient perception of treatment success and quality of life following total knee replacement operations. The majority of 79.4% of study participants expressed high levels of satisfaction alongside Quality of Life improvements after their total knee replacement surgery. Total knee replacement surgery proves effective as a treatment approach because it improves the life quality of people who suffer from painful knee disorders. The evaluation reveals that 17.1% of patients achieved moderate satisfaction along with QoL improvement after their knee replacement surgery. The 3.5% of patients with low satisfaction indicate potential postoperative complications or unfulfilled expectations and results.

Table 5: Shows Satisfaction and Qol Regarding Total Knee Replacement Surgery Score Results.

Table 6 shows that satisfaction with knee replacement surgery has statistically significant relation to residential region (P value=0.008), educational level (P value=0.025), marital status (P value=0.008), surgery date (P value=0.0001), height (P value=0.003), and weight (P value=0.001). It also shows statistically insignificant relation to gender, age, and type of operation. Participants of western region, holding a bachelor’s degree, married, 170 to 175 cm in height, and weighing 85 to 90 kg were found to have higher satisfaction levels than others.

Table 6: Relation Between Satisfaction with Knee Replacement Surgery and Sociodemographic Characteristics.

*p value was considered significant if ≤ 0.05.

Table 7 shows satisfaction and QoL with knee replacement surgery has statistically significant relation to gender (p value = 0.002), residential region (p value = 0.0001), marital status (p value = 0.012), surgery date (p value = 0.0001), and weight (p value = 0.0001). It also shows statistically insignificant relation to age, educational level, type of operation, and height. Participants who are of male gender, residing in western region, married, and weighing 84 kg or less were found to have higher satisfaction and quality of life than others.

Table 7: Satisfaction and Qol with Knee Replacement Surgery in Association with Sociodemographic Characteristics

*P value was considered significant if ≤ 0.05.

Health professionals consider Total knee arthroplasty (TKA) as an essential treatment method for severe knee osteoarthritis patients while their satisfaction levels with this surgical approach continue to receive substantial interest. The present study conducted as a cross-sectional survey aimed to measure TKA outcome satisfaction among Saudi Arabian patients. The majority of 79.8% of survey participants expressed elevated satisfaction levels following surgery which demonstrates the successful ability of TKA to enhance patient quality of life (QoL). Several previous studies verify these findings since most knee replacement surgery patients detect meaningful functional and pain improvement outcomes after their procedures. The results of systematic reviews indicate patients achieve measurable quality of life enhancements following total knee arthroplasty because their satisfaction numbers surpass 70% [13]. The positive satisfaction responses could be attributed to medical progress that has resulted in better surgical methods and post-treatment care which decreases adverse effects and hastens recovery [14].

Patient satisfaction after TKA proves to be highly impacted by various demographic characteristics of the individuals undergoing treatment. Our study along with other research establishes that residents living in the western area combined with individuals holding higher education degrees and those who are married tend to have better post-TKA satisfaction results. Health literacy increases following education according to previous research which studied patients undergoing comparable procedures [15] fSuccessfully improving patient compliance with surgeries recovery protocols. Postoperative patients benefit from social support networks since their marital status affects recovery by enhancing emotional stability while teaching adaptive coping methods [16]. The findings of our study support research from Tabassum et al. by demonstrating the importance of social and cultural conditions on patient recovery experiences after total knee arthroplasty [17].

The analysis demonstrates that significant associations exist between patient productivity improvements and satisfaction levels following medical procedures. Although most patients were satisfied with their post-operative experiences our research showed that 17.1% reported moderate satisfaction scores because their pain persisted beyond expectations. According to research high pain ratings three months after the procedure result in lasting dissatisfaction together with decreased functional outcomes [18]. The data shows that TKA achieves excellent outcomes for numerous patients but certain patients will need supplemental measures to achieve lasting satisfaction.

The discussion about functional improvements gained following surgery deserves specific attention for a proper assessment. Research supports our findings which show that 86.4% of patients experienced better physical capabilities after surgery for TKA since effective rehabilitation following TKA operations leads to improved mobility and functionality [19]. Joint stability along with long-term muscle strength may reach their potential peak through comprehensive rehabilitation programs which ensure optimal satisfaction levels according to research [14]. The recovery framework is multifactorial according to research [20] which shows that certain patients encounter ongoing limitations from psychological aspects and sustained pain. Such strong relationships between knee function and mental recovery episodes suggest that TKA patients need integrated treatment methods including mental health support.

The findings of this present work need attention regarding their capacity to generalize. Based on its nature as a geographic-area specific research this study restricts generalizable results to broader population groups. The research approach implemented diverse sampling but probably failed to properly include every demographic element which effects patient satisfaction. Studies have identified that surgical methods together with patient demographics and healthcare setup differences produce major impacts on TKA surgical outcomes as well as patient attitudes [21]. The small sample size of participants from selected demographics reduces the strength of the research findings thus new research should include participants from diverse backgrounds to improve widespread understanding of satisfaction factors.

Our research confirms patients in Saudi Arabia achieve significant satisfaction from their total knee replacement experiences according to established TKA effectiveness studies. The research demonstrates how individual patient contexts must guide personalized care strategies because demographic factors affect satisfaction outcomes. Advanced holistic care practices for TKA surgery require detailed monitoring of patients who encounter complications or unmet clinical expectations because of their dissatisfaction. Research advancements must focus on combining extensive patient experience evaluations with long-term monitoring because this combination will help enhance surgical post-operation care systems for various patient needs.

Acknowledgement

We acknowledge all of the volunteers who provided samples for this research.

Ethical approval

After fully explaining the study and emphasizing that participation is optional, each participant gave their informed consent. The information gathered was safely stored and utilized exclusively for study.

This study was not supported by any outside sources.

Conflict of interests

The authors declare no conflict of interest.

Informed consent

Written informed consent was acquired from each individual study participant.

Data and materials availability

All data associated with this study are present in the paper.

1. Li J. et al. "Key lifestyles and health outcomes across 16 prevalent chronic diseases: a network analysis of an international observational study." Journal of Global Health, vol. 14, 2024, p. 04068. https://doi.org/10.7189/jogh-14-04068.

2. Alshammari A.O. et al. "Awareness about total knee arthroplasty among Hail population." Cureus, 2023. https://doi.org/10.7759/cureus.33260.

3. Fatah R.M.N., Mahmud D.J. and Ahmad Z.M. "Patient satisfaction following primary total knee arthroplasty in Sulaimani city." 2019, vol. 5, no. 1, pp. 1–8. https://doi.org/10.5348/100014O03RF2019RA.

4. Deakin A.H. et al. "Fulfilment of preoperative expectations and postoperative patient satisfaction after total knee replacement: a prospective analysis of 200 patients." Knee, vol. 26, no. 6, 2019, pp. 1403–1412. https://doi.org/10.1016/j.knee.2019.07.018.

5. Smith A.F. et al. "Improved patient satisfaction following robotic-assisted total knee arthroplasty." Journal of Knee Surgery, vol. 34, no. 7, 2019, pp. 730–738. https://doi.org/10.1055/s-0039-1700837.

6. Alameri M.A. et al. "Quality of life post elective total joint replacement: a cross-sectional study from Saudi Arabia." 2022. https://doi.org/10.22377/ijpscr.v2i4.113.

7. Rooks K. et al. "Primary total knee arthroplasty: correlation between preoperative radiographic severity of arthritis and postoperative patient satisfaction." Journal of Knee Surgery, vol. 34, no. 13, 2020, pp. 1441–1445. https://doi.org/10.1055/s-0040-1710384.

8. Khanzada M.A. et al. "Primary total knee replacement: a recipe for dry dressing." Cureus, 2023. https://doi.org/10.7759/cureus.37820.

9. Sloan M., Premkumar A. and Sheth N.P. "Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030." Journal of Bone and Joint Surgery - American Volume, vol. 100, no. 17, 2018, pp. 1455–1460. https://doi.org/10.2106/JBJS.17.01617.

10. Nakano N. et al. "Why are patients dissatisfied following a total knee replacement? a systematic review." International Orthopaedics, vol. 44, no. 10, 2020, pp. 1971–2007. https://doi.org/10.1007/s00264-020-04607-9.

11. Felix J. et al. "Patient characteristics and valuation changes impact quality of life and satisfaction in total knee arthroplasty: results from a German prospective cohort study." Health and Quality of Life Outcomes, vol. 17, no. 1, 2019, pp. 1–10. https://doi.org/10.1186/s12955-019-1237-3.

12. Ware J., Kosinski M. and Keller S. "How to score SF-12." SF-12 v2 How to Score Version 2 SF-12 Health Survey, 1995, pp. 29–38.

13. Vasileiadis D. et al. "Does preoperative physiotherapy improve outcomes in patients undergoing total knee arthroplasty? a systematic review." Musculoskeletal Care, vol. 20, no. 3, 2022, pp. 487–502. https://doi.org/10.1002/msc.1616.

14. Lee J. et al. "The comparison of clinical features and quality of life after total knee replacement." Journal of Physical Therapy Science, vol. 29, no. 6, 2017, pp. 974–977. https://doi.org/10.1589/jpts.29.974.

15. Hirvonen J. et al. "Health-related quality of life in patients waiting for major joint replacement: a comparison between patients and population controls." Health and Quality of Life Outcomes, vol. 4, no. 1, 2006. https://doi.org/10.1186/1477-7525-4-3.

16. Lee H., An J. and Lee B. "The effect of progressive dynamic balance training on physical function, the ability to balance and quality of life among elderly women who underwent a total knee arthroplasty: a double-blind randomized control trial." International Journal of Environmental Research and Public Health, vol. 18, no. 5, 2021, p. 2513. https://doi.org/10.3390/ijerph18052513.

17. Tabassum M. et al. "Health related quality of life after total knee replacement in osteoarthritis patients." Journal of Health Research and Reports, vol. 3, no. 2, 2023, pp. 340–345. https://doi.org/10.61919/jhrr.v3i2.130.

18. Johns N. et al. "High pain reported at 3 months post-total knee arthroplasty often persists for the next 3 years and is associated with reduced function and quality of life." Musculoskeletal Care, vol. 22, no. 1, 2024. https://doi.org/10.1002/msc.1866.

19. Xu T. et al. "Efficacy and safety of a self-developed home-based enhanced knee flexion exercise program compared with standard supervised physiotherapy to improve mobility and quality of life after total knee arthroplasty: a randomized control study." Journal of Orthopaedic Surgery and Research, vol. 16, no. 1, 2021. https://doi.org/10.1186/s13018-021-02516-0.

20. Johns N. et al. "A systematic review of the effectiveness of rehabilitation therapy to treat people with chronic knee pain following a total knee replacement." 2020. https://doi.org/10.21203/rs.3.rs-70032/v1.

21. Christensen R. et al. "Effect of weight maintenance on symptoms of knee osteoarthritis in obese patients: a twelve-month randomized controlled trial." Arthritis Care & Research, vol. 67, no. 5, 2015, pp. 640–650. https://doi.org/10.1002/acr.22504.