The Satisfied Total Knee Replacement Patient: 3-Year Multicenter Results

- Kenneth A. Gustke, MD

Gustke, K., Golladay, G., Roche, M., Elson, L., Jerry, G., Anderson, C. “The satisfied total knee replacement patient: 3-year multicenter results.” EC Orthopaedics 9.3 (2018): 122-127.

At three years, 98.3% of sensor-assisted TKA patients reported being “satisfied” to “very satisfied,” according to this prospective study of patients whose knees were balanced with VERASENSE during surgery. The average satisfaction level reported in the literature at 2-3 years follow-up is 11.3% lower than this multicenter cohort (Figure 1). The multicenter study group thereby reflect the highest reported satisfaction levels for TKA patients in the literature to date.

Figure 1


The purpose of this study was to evaluate the three-year patient satisfaction levels following sensor-guided TKA and compare with previous publications that used various technologies/techniques for TKA. Eight sites (N = 176 patients) were involved with the multicenter sensor-guided cohort. All patients were implanted with the same implant design. These surgeons were relying on their standard TKA procedure in combination with VERASENSE technology to quantitatively balance the knee. Note that two of the surgeons contributing to this study used computer navigation for initial resections of the distal femur and proximal tibia.

Past research has demonstrated that as many as one in five patients are dissatisfied with the outcome of their total knee arthroplasty (TKA) and have historically reported higher pain levels and greater inhibition of function than total hip replacement patients. Amongst other factors, dissatisfaction following TKA may be attributed to a mismatch between patient expectations and their achievable activity levels1, as well as issues related to ligament imbalance.2-6 More than 40% of post-operative TKA complications are associated with soft tissue imbalance (e.g., stiffness, instability, and aseptic loosening).7-10


A comparative, systematic literature review was indexed in PubMed. Publications with 2–3 years post-operative follow-up were included in the analysis if the publication reported descriptive statistics of the relative number of patients reporting a “satisfied” or “very satisfied” outcome. The timeframe of publication for reasonable comparison ranges from January 2007 – October 2016.


The results from this study suggest that patients with quantitatively balanced knees do better than those who were potentially left in a quantitatively imbalanced state. Manual detection of soft tissue imbalance is challenging without quantifiable feedback. VERASENSE thereby offers real-time balancing data that allows the surgeon to make additional adjustments at the time of surgery. Sensor-assisted TKA may standardize soft tissue balancing practices and decrease the proportion of imbalanced knees.

Dr. Kenneth A. Gustke is a paid consultant to OrthoSensor, Inc.


    1. Dunbar MJ., et al. “I can’t get no satisfaction after my total knee replacement rhymes and reasons”. Bone and Joint Journal 95-B (2013):
    2. Pourzal R., et al. “How does wear rate compare in well-functioning total hip and knee replacements? A postmortem polyethylene liner study”. Clinical Orthopaedics and Related Research 474.8 (2016): 1867-1875.
    3. Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide: AOA (2015).
    4. O’Brien S., et al. “Comparison of hip and knee arthroplasty surgery”. Orthopedics 32.3 (2009): 168.
    5. de Beer J., et al. “Patient perspective survey of total hip vs total knee arthroplasty surgery”. Journal of Arthroplasty 27.6 (2012): 865-869.
    6. Babazadeh S., et al. “The relevance of ligament balancing in total knee arthroplasty: how important is it?” Orthopedic Reviews 1.2 (2009): e26.
    7. Callaghan JJ., et al. “Why knees fail: lessons learned”. Journal of Arthroplasty 19.4 (2004): 31-34.
    8. Fehring TK and Valadie AL. “Knee instability after total knee arthroplasty”. Clinical Orthopaedics and Related Research 299 (1994):157-162.
    9. Yercan HS., et al. “Tibiofemoral instability in primary total knee replacement: a review, Part 2: diagnosis, patient evaluation, and treatment”. Knee 12.5 (2005): 336-340.
    10. Becker R., et al. “Expectation, satisfaction, and clinical outcome of patients after total knee arthroplasty”. Knee Surgery, Sports Traumatology, Arthroscopy 19.9 (2011): 1433-1441.
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