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This study identifies optimal OKS values that discriminate post-operative (TKA) patient satisfaction and determines the variation in threshold values by patient characteristics and expectations. It is the first to identify patient improvement using measures (PoPC) that account for patient's pre-operative symptom severity. Of 365 primary TKA patients from a London district general hospital 84% were satisfied at 12 and 24 months. Whilst the overall OKS thresholds (follow-up, change, PoPC) were stable at 12 months (31, 11, 39.7%) and 24 months (35, 12, 38.9%), patients who were older (≥75years), were underweight/normal (BMI<25), had pre-operative symptom severity (OKS≤15) and expected no pain post-surgery, required a greater (potential) improvement to be classed as satisfied. When reporting good patient outcomes, cohorts should be stratified accordingly.

Original publication




Journal article


The Journal of arthroplasty

Publication Date





1364 - 1371


Oxford NIHR Musculoskeletal BRU to Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.


Humans, Osteoarthritis, Knee, Pain, Arthroplasty, Replacement, Knee, Postoperative Period, Cohort Studies, Follow-Up Studies, Research Design, Time Factors, Aged, Middle Aged, Patient Satisfaction, London, Female, Male, Symptom Assessment, Patient Outcome Assessment, Surveys and Questionnaires