Early Outcomes of Primary Total Knee Replacement: a Multicenter Study

Abstract

Background: The number of TKR surgeries performed daily in Kenyan hospitals is increasing significantly. Existing research shows that the procedure is associated with significant morbidity and complication risks. The incidence of early post-operative outcomes is unknown in Kenya. Objectives: To describe the early outcomes of Total Knee Replacement among patients undergoing the procedure in three hospitals in Kenya. Study design: Prospective cross-sectional study. Study site: Orthopedic units of Kenyatta National Hospital, Kiirua Hospital and Kikuyu Hospital. Methodology: Sixty-one patients had undergone the TKR procedure were recruited through consecutive sampling technique. Baseline characteristics included variables such as age, sex, and BMI. Patients were followed up prospectively and outcome variables included post-operative range of motion, pain score, the temperature difference between operated and non-operated knee, and altered sensation. Patient satisfaction was assessed using the Oxford Knee Score tool. Results: The mean age of study participants was 70.5 an SD 7.9, median of 70 years and a range of 52 – 85 years. Females were 45 (74%) and 16 (26%) were male patients. The mean BMI was 29.1, with a median of 28.3, an SD of 3.8, and a range of 19.3 to 37. The patients who received hospital-based physiotherapy were 45.9%, home-based were 36.1% of the patients while 18.0% of the patients received both home and hospital physiotherapy. The mean range of motion was 83.7 degrees (), SD 12.6, a median of 83.7 and a range of 60 to 113. The majority of the patients, 18 (29.5%), had a pain score of 3. The mean temperature difference was 0.18 with an SD of 0.131, the median was 0.179 with a range of 0 to 0.6. Forty-two patients (68.9%) had altered sensation while in 19 (31.1%), the sensation was not altered. According to Oxford Knee Score (OKS), the moderate score was 10 (16.4%), the good score was 42 (68.9%) and the excellent score was 9 (14.8%). Increasing age was associated with a decline in range of motion (p =0.001). Patients with higher BMI had a greater pain score while the greater the pain score the more the dissatisfaction according to the Oxford Knee Score. Conclusion: ROM was less than optimum after TKR and increasing age was associated with reduction in ROM. Majority of the patients reported moderate pain scores after TKR which lies in line with other similar studies. Patients reporting altered sensation were comparable to other studies. Patient satisfaction after TKR is comparable to other settings. This study provides valuable information that can be used to improve the quality of care and the outcomes of TKR in Kenya.