Patient reported outcome measures review: Are current outcomes assessment tools sensitive enough to assess the reasons for patients’ “unhappiness”?

In an effort to improve patient quality of life after total knee arthroplasty, there is a growing focus on patient reported outcome measures (PROMs) to help clinicians gauge procedure success. Many existing PROMs are subject to the ceiling effect as the measures tested do not apply to younger patients and a more active older population with higher levels of function. Patient survey questions may lack the sensitivity and specificity to properly evaluate high performing total knee arthroplasty implants in high demand populations. Recently developed PROMs improve the ability to differentiate outcomes between patients with high levels of function but need to be tested on a wider scale. While objective measures and physician reports are still important, further work is needed to create PROMs that explain why certain patients are not satisfied with their total knee arthroplasty. The aim of this review is to evaluate the ability of current orthopaedic PROMs to detect patient “unhappiness”.