Abstract

Despite high success rates of total knee arthroplasty (TKA), up to 20% of patients report dissatisfaction. Physician continuity—receiving indication, surgery, and follow-up from the same physician—may improve communication, trust, adherence, and satisfaction, yet its effect has rarely been investigated. This retrospective study included 237 patients who underwent primary TKA between January 2020 and March 2024. Patients were categorized into four groups based on physician continuity: Group 1 (n = 68), different physicians at all stages; Group 2 (n = 60), same physician for surgery and follow-up; Group 3 (n = 56), same physician for indication and surgery; Group 4 (n = 53), same physician across all stages. Outcomes included WOMAC and Forgotten Joint Score-12 (FJS-12), EQ-5D-3L and EQ-VAS, and an eight-item satisfaction questionnaire (Cronbach’s α = 0.83). Baseline demographic and radiological variables were similar between groups (all p > 0.05). Significant differences were found in postoperative WOMAC, ΔWOMAC, FJS-12, EQ-5D-3L, EQ-VAS, and satisfaction scores (all p < 0.001). Group 4 (full continuity) achieved the best results, followed by Group 3 (partial continuity), whereas Group 1 showed the lowest outcomes. In multivariable analysis, full physician continuity remained independently associated with superior functional and satisfaction outcomes after adjustment for baseline and clinical variables. Minor complications occurred in 8.4% of patients, with no significant differences between groups (p = 0.91). Physician continuity throughout the TKA pathway is associated with better functional outcomes, higher satisfaction, and improved quality of life. Even partial continuity provides measurable benefits and minimizing physician changes may enhance postoperative recovery.

Key words: Total knee arthroplasty, physician continuity, patient satisfaction, functional outcomes, quality of life