Effects of improved visual appearance on clinical outcomes after total knee arthroplasty: a randomized controlled trial

BACKGROUND: Despite advancements in total knee arthroplasty (TKA), some patients remain dissatisfied postoperatively, potentially due to subjective perceptions of knee appearance. This study investigated whether visual feedback on improved knee alignment and appearance after TKA influences pain perception and patient-reported outcomes. METHODS: In this prospective, double-blind, randomized controlled trial, 60 patients undergoing primary TKA were randomized into intervention or control groups (n = 30 each). Pre- and postoperative radiographs, photographs, and gait videos were collected. Patient-reported outcomes were measured using the Visual Analogue Scale (VAS), Oxford Knee Score (OKS), and SF-36 survey. Three months postoperatively, the intervention group received visual feedback via their pre/post images and gait videos, while the control group received routine follow-up only. RESULTS: Forty-nine patients were included in the final analysis. Baseline characteristics were similar. After the intervention, the VAS score was significantly lower in the intervention group than in the control group [1.00 (1.00, 2.00) vs. 2.00 (1.25, 3.00), P < 0.05], and SF-36 physical health scores improved significantly. Within-group analysis showed significant improvements in VAS, OKS, and SF-36 in the intervention group, while only OKS improved in the control group. Change-score analysis revealed a significantly greater reduction in pain in the intervention group [ΔVAS 1.00 (1.00, 2.00) vs. 0.00 (0.00, 0.00), P < 0.01]. CONCLUSIONS: Visual feedback on postoperative knee alignment may improve pain perception and patient satisfaction after TKA. Incorporating standardized image and gait documentation into follow-up recovery may enhance patient satisfaction and perceived outcomes. TRIAL REGISTRATION: chictr.org.cn, ChiCTR2300076318, Registration date: 01 October 2023.