Identifying Predictors of Unsatisfactory Outcomes After Unicompartmental Knee Arthroplasty: A Retrospective Cohort Analysis of 978 Patients

Identifying Predictors of Unsatisfactory Outcomes After Unicompartmental Knee Arthroplasty: A Retrospective Cohort Analysis of 978 Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Identifying Predictors of Unsatisfactory Outcomes After Unicompartmental Knee Arthroplasty: A Retrospective Cohort Analysis of 978 Patients Guorong Zhang, Cong Wang, Yihui Liu, Desheng Chen, Zhigang Bai, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8767610/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 23 You are reading this latest preprint version Abstract Background Medial compartment knee osteoarthritis is common. Unicompartmental knee arthroplasty (UKA) offers a bone-preserving alternative to total knee replacement. Despite its advantages, patient dissatisfaction remains a concern, impacting perceived success beyond implant survival rates. Current evidence lacks a focused analysis of the specific factors driving patient dissatisfaction after UKA, particularly regarding residual symptoms and functional limitations. This study aimed to identify the key independent risk factors for dissatisfaction following UKA. Methods A retrospective analysis was conducted on the clinical data of patients who underwent UKA in the Department of Joint Surgery, Ningxia Hui Autonomous Region People's Hospital, between January 1, 2017, and December 31, 2023. Postoperative outcome data were collected via telephone and outpatient follow-up. Results Univariate analysis revealed significant differences (P < 0.05) between the satisfied and dissatisfied groups regarding surgeon-related factors, prosthesis type, patellar Wiberg classification, age, kneeling ability, stair-related pain, walking pain, knee instability, HSS score, WOMAC score, and FJS score. No significant differences were found in operative side, gender, BMI, ASA grade, symptom duration, or posterior tibial slope. Multivariate logistic regression analysis identified kneeling difficulty, stair-related pain, walking pain, and knee instability as independent risk factors for dissatisfaction. Conclusion Multivariate analysis indicates that postoperative kneeling difficulty, stair-related pain, walking pain, and knee instability are independent risk factors for patient dissatisfaction. Additionally, factors related to the surgeon (as evidenced by inter-surgeon variation in outcomes), prosthesis type, and preoperative patellar morphology were also associated with satisfaction levels. Trial registration It is a retrospective registered, no registration was performed. Unicompartmental Knee Arthroplasty Patient Satisfaction Pain Logistic Regression Analysis Figures Figure 1 Figure 2 Introduction Knee osteoarthritis (KOA) is a prevalent degenerative disease among middle-aged and elderly individuals, severely impacting patients' quality of life and imposing a substantial socio-economic burden[1],Currently, it is estimated that 528 million people are affected globally, with a prevalence rate of 23% in those aged over 40[2].Research indicates that KOA does not invariably involve all three compartments of the knee; approximately 85% of cases primarily affect the medial compartment[3],Consequently, unicompartmental knee arthroplasty (UKA) presents a viable alternative for a subset of patients in managing knee arthritis[4],Favored by many orthopedic surgeons for its advantages such as minimal invasiveness, bone preservation, rapid recovery, and potentially superior knee kinematics[5, 6],studies suggest that around 47% of patients with KOA are candidates for UKA. Nonetheless, the utilization rate of UKA remains low, at only 5-8%[7, 8].Despite continuous advancements in surgical techniques and instrumentation, a discrepancy in patient satisfaction persists between UKA and total knee arthroplasty (TKA). Studies report that the lifetime revision risk for UKA is approximately twice that of TKA (UKA ranging from 3.7% to 40.4% vs. TKA from 1.6% to 22.4%)[9],This higher revision rate may be one factor influencing the choice of procedure. The reasons for UKA failure are multifaceted, including progression of arthritis in the contralateral compartment, aseptic loosening, infection, and mobile bearing dislocation. These complications not only affect surgical success rates but are also significant contributors to postoperative patient dissatisfaction. However, beyond revision rates, patient-reported satisfaction is a crucial subjective metric for evaluating procedural success.Currently, research specifically investigating patient satisfaction following UKA, particularly within distinct regional populations, is lacking. This study systematically analyzes clinical data from patients who underwent UKA at the Department of Joint Surgery, Ningxia Hui Autonomous Region People's Hospital, between January 1, 2017, and December 31, 2023. It aims to identify the key factors influencing postoperative satisfaction in this cohort, thereby providing targeted guidance for preoperative counseling, patient selection, surgical technique optimization, and postoperative rehabilitation. Materials and Methods Study Population This retrospective study analyzed the clinical data of patients who underwent UKA at the Department of Joint Surgery, Ningxia Hui Autonomous Region People's Hospital, between January 1, 2017, and December 31, 2023. The study protocol was reviewed and approved by the Hospital Ethics Committee (Approval No. 2025-WJW-004). Inclusion and Exclusion Criteria Inclusion Criteria: Diagnosis of single-compartment knee osteoarthritis, predominantly affecting the medial compartment, confirmed by clinical and imaging examinations; first-time UKA treatment; availability of complete preoperative knee function scores and imaging data; absence of severe cardiovascular, cerebrovascular, hepatic, or renal diseases. Exclusion Criteria: Concurrent severe cardiovascular or cerebrovascular diseases, or hepatic/renal insufficiency; inflammatory joint diseases such as rheumatoid arthritis; psychiatric disorders or cognitive impairment precluding follow-up cooperation; patients who received bilateral UKA to ensure unilateral assessment independence and sample homogeneity. Based on these criteria, 978 patients were included: 276 males and 702 females. Age ranged from 44 to 88 years (mean: 64.41 ± 7.92 years). Follow-up duration ranged from 20 to 102 months (mean: 49.56 ± 19.36 months). Regarding prosthesis type: 592 received a mobile-bearing prosthesis, and 386 received a fixed-bearing prosthesis. (Fig.1) Research Methods Surgical Technique All surgeries were performed by different senior surgeons, all of whom had undergone formal arthroplasty training. A medial parapatellar approach or a minimally invasive approach was selected based on the patient's specific condition. The surgical goal was to restore the physiological lower limb alignment (posterior tibial slope was determined based on patient anatomy and prosthesis design). Trial components were used to ensure balanced flexion and extension gaps and appropriate ligament tension. Upon satisfactory testing, cemented fixation of the components was performed. The fixed-bearing prosthesis used was the Link® Sled; the mobile-bearing prosthesis used was the Zimmer Biomet Oxford Unicompartmental Knee. Assessment Parameters Data were collected through outpatient reviews and telephone follow-ups, which specifically included: demographic information (age, gender, body mass index, and education level), symptom duration, preoperative patellar Wiberg classification, prosthesis type, complications, postoperative Hip-Knee-Ankle Angle (HKA) and Posterior Tibial Slope (PTS), as well as functional scores at the final follow-up—the Hospital for Special Surgery Knee Score (HSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Forgotten Joint Score-12 (FJS-12). The assessment of knee instability was primarily based on patients' reports of giving way, buckling, or a sense of instability during daily activities, as recorded in follow-up interviews. Standardized physical stress tests for instability were not routinely performed. Wiberg classification : There are two physicians evaluated the patella using 90° axial X-ray films, knee CT scans and MRI images according to the Wiberg classification system. Wiberg Type I: Both medial and lateral patellar articular surfaces are essentially symmetrical (I); Wiberg Type II: The lateral articular surface is larger than the medial one (Group II); Wiberg Type III: The medial articular surface is extremely small or absent (Group III) Satisfaction Assessment: A 5-point Likert scale (very satisfied, satisfied, neutral, dissatisfied, very dissatisfied) was used. Responses of "very satisfied" and "satisfied" were defined as "satisfied"; "neutral," "dissatisfied," and "very dissatisfied" were defined as "dissatisfied." Statistical Analysis Data analysis was performed using SPSS 26.0. Continuous variables are presented as mean ± standard deviation. After normality was confirmed by the Shapiro-Wilk test, intergroup comparisons were made using the t-test, reporting effect size (d value) and 95% confidence interval (CI). Categorical variables are presented as number (percentage). Intergroup comparisons were made using the χ² test, reporting association strength (φ coefficient or Cramer's V). Variables with P<0.05 in the univariate analysis were included in a binary logistic regression model for multivariate analysis. Categorical variables were treated as dummy variables. The "Enter" method was used for model building. Odds ratios (OR) and their 95% CIs are reported. A P-value <0.05 was considered statistically significant. Results Patient Satisfaction Distribution and Overview A total of 978 patients were included. Among them, 811 (82.9%) were satisfied with the treatment outcome, and 167 (17.1%) were dissatisfied. Effect size analysis indicated large effects for the HSS score (d=3.54) and WOMAC score (d=1.04). Stair-related pain (φ=0.44), walking pain (φ=0.34), and the ability to kneel fully (φ=0.36) showed medium effect sizes, constituting the main clinical symptoms and functional limitations contributing to dissatisfaction. Age also showed a medium effect size (φ=0.27), indicating significantly higher satisfaction among elderly patients (>60 years). (Table.1) Comparison of General Characteristics Between Groups Univariate analysis revealed significant differences (P<0.05) between the groups in the following variables: Patellar Wiberg classification (χ² = 9.284, p=0.01, Cramer's V =0.097): Type III was associated with the highest dissatisfaction rate. Prosthesis type (χ² = 19.03, p<0.001, Phi φ = 0.139): Satisfaction was significantly higher in the mobile-bearing group. Surgeon (χ² =9.284, p=0.01, Cramer's V =0.097): Patient satisfaction varied among different surgeons, with one surgeon's group showing the highest satisfaction proportion. Age (χ² =70.732, p60 years old. (Table.2) Knee Function Outcome Indicators Significant differences were found between the satisfied and dissatisfied groups in: Ability to kneel fully (χ² =123.456, p<0.001, Phi φ =0.355); Stair-related pain (χ² =185.001, p<0.001, Phi φ =0.435); Walking pain (χ² =110.832, p<0.001, Phi φ =0.337); Knee instability (χ² =48.869, p<0.001, Phi φ=0.224). Furthermore, the dissatisfied group had a significantly higher WOMAC score (t =-13.233, p<0.001, 95% CI: -14.142, -8.799, d=1.04) and significantly lower HSS score (t=46.859, p<0.001, 95% CI: 4.855, 6.682, d=3.54) and FJS-12 score (t =4.304, p<0.001, 95% CI: 0.966, 2.586, d=0.35). The dissatisfied group also had a significantly smaller HKA angle (t=4.167, p0.05) were found between satisfaction and the following: gender, operative side, education level, posterior tibial slope, symptom duration, follow-up time, body mass index (BMI), or American Society of Anesthesiologists (ASA) physical status classification. (Table.1&2) Distribution of Patient-Reported Postoperative Symptoms The most commonly reported postoperative symptoms, in descending order of frequency, were: stair-related pain, walking pain, knee instability, and lateral compartment pain. (Fig.2) Multivariate Logistic Regression Analysis Variables with P<0.05 in the univariate analysis were entered into the multivariate logistic regression model. The results identified the following as independent risk factors for dissatisfaction after UKA: Kneeling ability (OR=0.128, 95%CI: 0.079-0.206), Walking pain (OR=9.463,95%CI:5.591-16.014), Knee instability (OR=3.988, 95%CI:2.179-7.298), and Stair-related pain (OR=8.783, 95%CI:5.588-13.803). Notably, an OR<1 for kneeling ability indicates that being able to kneel fully is a strong protective factor for satisfaction (OR=0.128). (Table.3) Discussion Based on the analysis of clinical data from 978 UKA patients, this study found a postoperative satisfaction rate of 82.9%. This figure provides a benchmark specifically focused on the efficacy of unilateral surgery. We excluded patients who underwent bilateral UKA to ensure the independence of the unilateral assessment, thereby avoiding confounding bias in satisfaction evaluation due to functional interaction between both knees. This methodological choice may partly explain the observed satisfaction rate in our study compared to some research that included bilateral cases. Dissatisfaction following UKA was closely associated with factors including the surgeon, prosthesis type, patellar morphology, age, kneeling ability, stair-related pain, walking pain, and knee instability. Most importantly, multivariate analysis identified kneeling difficulty, stair-related pain, walking pain, and knee instability as independent risk factors for dissatisfaction.Our univariate analysis revealed significant variation in satisfaction rates among surgeons, with Surgeon A’s cohort demonstrating the highest proportion of satisfied patients (Table 2). While this study was not designed to compare specific technical nuances, possible contributing factors may include differences in surgical approach, soft-tissue balancing technique, implant positioning preferences, or volume of UKA performed. Further prospective studies with standardized technique documentation are needed to elucidate which technical aspects most strongly influence patient-reported outcomes. Influence of Surgical Technique and Prosthesis on Satisfaction Research has identified inherent varus deformity in 17% of female and 32% of male patients in Asian populations, with studies suggesting that mild varus alignment post-total knee arthroplasty (TKA) may correlate with better functional outcomes [10],For medial UKA, a postoperative varus alignment of 1-4° is associated with optimal functional results and implant survival[11].This is supported by the work of Slaven et al., who reported that well-functioning UKA patients demonstrated approximately 4° of mild varus mechanical alignment at a 10-year follow-up[12],In our study, the dissatisfied group exhibited a smaller hip-knee-ankle (HKA) angle, a difference that was statistically significant but with a low effect size, and this variable was not an independent factor in the multivariate analysis. This suggests a complex and potentially non-linear relationship between lower limb alignment and patient satisfaction, warranting further investigation.While 85% of osteoarthritis cases primarily involve the medial compartment[3],the disease process often represents a broader degenerative progression. Consequently, after addressing the medial compartment, abnormal pressure changes in the lateral compartment become a critical factor affecting overall knee contact stress and serve as a biomechanical basis for postoperative pain and instability[13],Therefore, within the boundaries of established indications for UKA[14], achieving a patient-specific, moderate alignment correction may be more conducive to enhancing satisfaction.Our results (Table 2) revealed significant variation in patient satisfaction among different surgeon groups, a finding consistent with arthroplasty registry data highlighting the importance of surgical experience and procedural volume on UKA outcomes[15, 16]This highlights that both case volume accumulation and progression along the learning curve are equally important for improving surgical outcomes. Prosthesis stability is crucial for activities requiring high degrees of knee flexion, such as deep squatting. Previous studies have confirmed that with meticulous surgical technique, Asian patients can achieve good functional results following medial UKA.[17]. Our study observed that satisfaction and perceived range of motion were lower with fixed-bearing prostheses compared to mobile-bearing designs. This may be attributed to the mobile-bearing design philosophy, which more closely replicates natural knee kinematics and has been associated with favorable long-term wear characteristics in biomechanical studies[18]. However, the direct link between polyethylene wear and early patient satisfaction remains uncertain.Furthermore, studies indicate that fixed-bearing UKA may increase lateral compartment pressure, whereas mobile-bearing designs better approximate physiological knee loading[19], However, given the retrospective nature of our study, the choice of prosthesis may have been subject to selection bias based on patient indications. This observation requires validation through prospective studies. Influence of Patient Factors on Satisfaction The impact of age on postoperative satisfaction following UKA is multifaceted. The univariate analysis in this study indicated that younger patients (age ≤ 60 years) reported significantly lower satisfaction than their older counterparts (age > 60 years), a finding consistent with some existing literature. For instance, Kleeblad et al. [20]observed that among UKA patients satisfied with their ability to return to sports, the satisfaction rate was higher in the 70-year-old age group (93.1%) compared to the 55-year-old group (77.8%). A meta-analysis also suggested that early return to physical activity postoperatively may be associated with better outcomes[21]. However, in the multivariate analysis of our study, age was not identified as an independent risk factor for dissatisfaction (P=0.294). This suggests that the lower satisfaction observed in younger patients may not be directly attributable to age per se , but rather mediated indirectly through other age-correlated factors. Younger patients typically have higher activity levels and greater functional expectations[22], which may render them more sensitive to residual postoperative pain or functional limitations (such as stair-related or walking pain), thereby reducing their overall satisfaction. In other words, age likely serves as a surrogate marker for patient expectations and activity demands, whereas satisfaction is more directly influenced by the achievement of the specific functional states corresponding to those expectations.Concerning body mass index (BMI), traditional perspectives, such as the Scott criteria, often regard severe obesity (e.g., BMI > 35-40) as a relative contraindication for UKA, primarily due to concerns about implant survival under high mechanical loads. Our findings align with recent studies[23, 24].Showing no significant association between BMI and patient-reported satisfaction in the early postoperative period. This indicates that UKA remains an effective treatment option for obese patients in terms of pain relief and functional improvement. Nevertheless, clinicians should thoroughly inform these patients about the potential long-term risks of increased wear and higher revision rates during preoperative counseling. Analysis of Core Symptoms and Functional Limitations Influencing Satisfaction Complications following unicompartmental knee arthroplasty, such as implant loosening, wear, dislocation, and infection, are critical factors affecting long-term outcomes and implant survival, with aseptic loosening being a leading cause of revision[25]. However, this study suggests that early subjective patient dissatisfaction is more directly driven not by these traditional major complications, but by a constellation of clinical symptoms dominated by pain and functional impairments. Multivariate analysis identified walking pain (OR=9.463), stair-related pain (OR=8.783), knee instability (OR=3.988), and restricted kneeling ability (OR=0.128) as independent risk factors for dissatisfaction. The exceptionally high odds ratios for the various pain symptoms designate them as the strongest predictors of dissatisfaction.The etiology of these pain symptoms is diverse. Early postoperative pain may be related to surgical trauma, soft tissue inflammation, or the rehabilitation process. In contrast, persistent or new-onset pain in the mid- to long-term should raise suspicion for disease progression in the contralateral compartment or the patellofemoral joint. Our findings support the view that degeneration of the lateral compartment and the patellofemoral joint constitutes a significant source of postoperative pain[26]. The biomechanical rationale is that while UKA addresses the pathology and alignment of the medial compartment, it may alter the overall stress distribution across the knee. If pre-existing early degeneration in the lateral or patellofemoral compartments or underlying limb malalignment is present, the postoperative redistribution of joint loads may accelerate the pathological process in these areas, manifesting as pain during walking or stair climbing. Therefore, postoperative pain is not only a direct cause of dissatisfaction but may also serve as a clinical indicator of altered biomechanics or disease progression in other compartments of the knee.Beyond pain, the inability to achieve a full kneeling posture postoperatively emerged as a potent independent risk factor for dissatisfaction. This is far more than a simple functional metric; it carries significant biomechanical implications and reflects culturally specific activities of daily living. From a biomechanical perspective, achieving a comfortable kneeling posture requires deep knee flexion, often exceeding 130°-150°, and places high demands on patellofemoral and tibiofemoral joint coordination, quadriceps strength, and soft tissue balance[27]. Difficulty kneeling after UKA may indicate several issues: (1) prosthesis design or placement limiting maximum flexion, particularly due to posterior tibial component or polyethylene insert impingement; (2) abnormal patellofemoral tracking or progressive degeneration; or (3) postoperative capsular or soft tissue contracture leading to loss of deep flexion. Thus, 'the ability to kneel' serves as a high-order functional marker, reflecting surgical precision, prosthesis performance, and the state of the patellofemoral joint. Culturally, for the study population—which includes a significant number of Hui ethnic individuals—and many Asian communities, kneeling is essential for daily activities (e.g., domestic chores, sitting) and religious practices. This deeply ingrained functional need directly shapes patients' postoperative expectations and their definition of surgical success, a notion supported by prior research linking high-flexion activities to satisfaction[28]Our study further identified a significant association between preoperative patellar morphology and both postoperative kneeling ability and satisfaction. Univariate analysis showed the highest dissatisfaction rate among patients with Wiberg type III patellae. This can be explained anatomically and biomechanically. The type III patella is characterized by a prominent lateral facet, a very small medial facet, and a medially displaced central ridge[29]. This morphology leads to abnormally concentrated contact stress on the lateral patellofemoral joint, predisposing to excessive lateral pressure syndrome (ELPS) and severe cartilage wear [30]. Concomitant changes in the Q-angle may further exacerbate patellar maltracking. Additionally, the type III patella is more prone to "tendofemoral contact" (contact between the patellar tendon and femur) during deep flexion, possibly an adaptive change to reduce focal cartilage pressure, but one that inherently limits high-flexion capacity. Consequently, patients with type III patellae are likely to encounter greater difficulty and discomfort during postoperative activities requiring deep flexion or high stress, such as stair climbing or kneeling. This persistent functional limitation, by impairing daily and culturally specific activities, indirectly lowers overall satisfaction. This underscores the importance of identifying Wiberg type III patellae during preoperative UKA assessment. Research suggests that correcting abnormal patellar morphology through techniques like patelloplasty may improve patellofemoral biomechanics and enhance postoperative functional outcomes and satisfaction[31]Finally, knee instability was also an independent factor for dissatisfaction. Although its OR was lower than that for pain symptoms, it warrants attention. The sensation of instability, which may stem from suboptimal ligament balance, improper implant positioning, or progressive joint laxity, can undermine patient confidence during activities, especially when turning or walking on uneven surfaces. Based on this analysis, we propose that for patients with demands for deep flexion, preoperative assessment should include detailed inquiry into functional expectations and evaluation of patellar Wiberg classification. Intraoperatively, efforts should focus on achieving optimal implant matching, alignment restoration, and ligament balance, avoiding overstuffing or excessive tightness in the flexion gap. Postoperative rehabilitation should incorporate progressive deep flexion and stability training. Future prospective studies are needed to validate whether such a personalized surgical and rehabilitative approach, aimed at alleviating core symptoms and restoring specific functional needs, can systematically enhance patient satisfaction. This study has several limitations. First, as a single-center, retrospective study, it is susceptible to selection bias, and the identified associations do not establish causality between the factors and satisfaction. Second, satisfaction is a subjective measure that may be influenced by unmeasured patient expectations and psychological factors. Third, although we identified pain as a primary factor, we did not perform a stratified analysis of its specific etiologies (e.g., loosening, progressive arthritis). Finally, the conclusions are drawn from data of a single center in Northwest China, and their generalizability requires validation through multicenter studies. Future prospective research is needed to confirm these risk factors and explore targeted intervention strategies. This study confirms that satisfaction following UKA is primarily driven by residual postoperative symptoms and functional limitations, specifically walking pain, stair-related pain, knee instability, and kneeling difficulty. Kneeling difficulty is particularly significant within specific cultural contexts. The refinement of surgical technique (e.g., by experienced surgeons), optimization of prosthesis selection, and preoperative assessment of the patellofemoral joint status are also crucial for meeting patient expectations. Patients, especially those with high activity demands, should be thoroughly counseled preoperatively regarding these potential risks. Abbreviations Unicompartmental Knee Arthroplasty UKA Knee Osteoarthritis KOA Total Knee Arthroplasty TKA Body Mass Index BMI Hip-Knee-Ankle Angle HKA Posterior Tibial Slope PTS Hospital for Special Surgery Knee Score HSS Western Ontario and McMaster Universities Osteoarthritis Index WOMAC Forgotten Joint Score-12 FJS-12 American Society of Anesthesiologists ASA Odds Ratio OR Confidence Interval CI Excessive Lateral Pressure Syndrome ELPS Declarations Acknowledgements The authors gratefully acknowledge all the collaborators and participants who contributed to this study. Author contributions Zhang and C. Wang contributed equally as co-first authors, responsible for study conception, design, analysis, and manuscript drafting. Y. Liu contributed to data curation and formal analysis. D. Chen and Z. Bai contributed to investigation and data collection. Y. Liang supervised the project and provided critical revision. All authors reviewed and approved the final manuscript. Funding This trial was partially funded by the Ningxia Health Commission (No. 2025-NWZC-B006). Ningxia Science and Technology Transformation Project 2025 (Application and promotion of remote precision medical system for hip and knee joints based on surgical robots：NO.2025CJE09011）The funding source did not play any role in the study design. Data availability All data generated or analysed during this study are included in this published article and its supplementary information files. Declarations Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Ningxia Hui Autonomous Region(Approval No.2025-WJW-004). Informed consent was obtained from all individual participants included in the study. 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Tables Table 1 Comparison of continuous data between two groups of patients satisfied（811） dissatisfied（167） T P 95%CI Follow-up time（months） 49.32±19.63 50.76±17.94 -0.877 0.117 -4.671,1.786 Symptom duration（months） 6.12±2.84 5.99±3.02 0.542 0.588 -0.346,0.611 WOMAC 47.22±15.59 65.46±19.02 -13.233 <0.001 -14.142,-8.799 HSS 89.83±5.11 67.98±7.06 46.859 <0.001 4.855,6.682 FJS-12 78.22±4.72 76.45±5.46 4.304 <0.001 0.966,2.586 HKA 174.22±2.22 173.54±1.85 4.167 <0.001 0.318,1.039 PJS 8.61±2.27 8.62±2.27 -0.014 0.989 -0.381,0.376 Table 2 Comparison of categorical variables between two groups of patients satisfied（811） dissatisfied（167） χ² p gender Men 228(28.11%) 48(28.74%) 0.27 0.869 Women 583(71.89) 119(71.26%) wiberg 1 280(34.53%) 42(25.15%) 13.596 0.001 2 420(51.79%) 85(50.90%) 3 111(13.68%) 40(23.95%) side right 481（59.31%） 86（51.48%） 3.469 0.063 left 330（40.69%） 81（48.52%） Prosthesis type fixed 476(58.70%) 116(69.46%) 6.721 0.01 movable 335(41.3%) 51(30.54%) Education level junior school 708(87.30%) 146(87.42%) 0.002 0.969 High school and above 103(12.70%) 21(12.58%) surgeon a 358（44.14%） 20（11.98%） 42.021 60 573（70.65%） 61（36.53%） 70.732 <0.001 ≤60 238（29.35%） 106（63.47%） BMI normal 262（32.31%） 63（37.72%） 3.725 0.155 overweight 421（51.91%） 73（43.72%） Obese 128（15.78%） 31（18.56%） kneeling yes 546（67.32%） 35（20.96%） 123.456 <0.001 no 265（32.68%） 132（79.04%） Stair-related pain yes 102（12.58%） 99（59.28%） 185.001 <0.001 no 709（87.42%） 68（40.72%） Walking pain yes 84（10.36%） 72（43.11%） 110.832 <0.001 no 727（89.64%） 95（56.89%） Knee Instability yes 58（7.15%） 42（25.15%） 48.869 <0.001 no 753（92.85%） 125（74.85%） ASA 2 600（73.98%） 116（69.46%） 1.444 0.230 3,4 211（26.02%） 51（30.54%） Table 3 Logistic regression analysis results OR SE 95% CI P Age 0.783 0.233 0.496,1.236 0.294 kneeling 0.128 0.244 0.079,0.206 <0.001 knee instability 3.988 0.308 2.179,7.298 <0.001 Stair-related pain 8.783 0.231 5.588,13.803 <0.001 walking pain 9.463 0.268 5.591,16.014 <0.001 Additional Declarations No competing interests reported. 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quality of life and imposing a substantial socio-economic burden[1],Currently, it is estimated that 528 million people are affected globally, with a prevalence rate of 23% in those aged over 40[2].Research indicates that KOA does not invariably involve all three compartments of the knee; approximately 85% of cases primarily affect the medial compartment[3],Consequently, unicompartmental knee arthroplasty (UKA) presents a viable alternative for a subset of patients in managing knee arthritis[4],Favored by many orthopedic surgeons for its advantages such as minimal invasiveness, bone preservation, rapid recovery, and potentially superior knee kinematics[5, 6],studies suggest that around 47% of patients with KOA are candidates for UKA. Nonetheless, the utilization rate of UKA remains low, at only 5-8%[7, 8].Despite continuous advancements in surgical techniques and instrumentation, a discrepancy in patient satisfaction persists between UKA and total knee arthroplasty (TKA). Studies report that the lifetime revision risk for UKA is approximately twice that of TKA (UKA ranging from 3.7% to 40.4% vs. TKA from 1.6% to 22.4%)[9],This higher revision rate may be one factor influencing the choice of procedure. The reasons for UKA failure are multifaceted, including progression of arthritis in the contralateral compartment, aseptic loosening, infection, and mobile bearing dislocation. These complications not only affect surgical success rates but are also significant contributors to postoperative patient dissatisfaction. However, beyond revision rates, patient-reported satisfaction is a crucial subjective metric for evaluating procedural success.Currently, research specifically investigating patient satisfaction following UKA, particularly within distinct regional populations, is lacking. This study systematically analyzes clinical data from patients who underwent UKA at the Department of Joint Surgery, Ningxia Hui Autonomous Region People\u0026apos;s Hospital, between January 1, 2017, and December 31, 2023. It aims to identify the key factors influencing postoperative satisfaction in this cohort, thereby providing targeted guidance for preoperative counseling, patient selection, surgical technique optimization, and postoperative rehabilitation.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study analyzed the clinical data of patients who underwent UKA at the Department of Joint Surgery, Ningxia Hui Autonomous Region People's Hospital, between January 1, 2017, and December 31, 2023. The study protocol was reviewed and approved by the Hospital Ethics Committee (Approval No. 2025-WJW-004).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria:\u003c/strong\u003e Diagnosis of single-compartment knee osteoarthritis, predominantly affecting the medial compartment, confirmed by clinical and imaging examinations; first-time UKA treatment; availability of complete preoperative knee function scores and imaging data; absence of severe cardiovascular, cerebrovascular, hepatic, or renal diseases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria:\u003c/strong\u003e Concurrent severe cardiovascular or cerebrovascular diseases, or hepatic/renal insufficiency; inflammatory joint diseases such as rheumatoid arthritis; psychiatric disorders or cognitive impairment precluding follow-up cooperation; patients who received bilateral UKA to ensure unilateral assessment independence and sample homogeneity.\u003cbr\u003e Based on these criteria, 978 patients were included: 276 males and 702 females. Age ranged from 44 to 88 years (mean: 64.41 ± 7.92 years). Follow-up duration ranged from 20 to 102 months (mean: 49.56 ± 19.36 months). Regarding prosthesis type: 592 received a mobile-bearing prosthesis, and 386 received a fixed-bearing prosthesis.\u003cstrong\u003e(Fig.1)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll surgeries were performed by different senior surgeons, all of whom had undergone formal arthroplasty training. A medial parapatellar approach or a minimally invasive approach was selected based on the patient's specific condition. The surgical goal was to restore the physiological lower limb alignment (posterior tibial slope was determined based on patient anatomy and prosthesis design). Trial components were used to ensure balanced flexion and extension gaps and appropriate ligament tension. Upon satisfactory testing, cemented fixation of the components was performed. The fixed-bearing prosthesis used was the Link® Sled; the mobile-bearing prosthesis used was the Zimmer Biomet Oxford Unicompartmental Knee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment Parameters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected through outpatient reviews and telephone follow-ups, which specifically included: demographic information (age, gender, body mass index, and education level), symptom duration, preoperative patellar Wiberg classification, prosthesis type, complications, postoperative Hip-Knee-Ankle Angle (HKA) and Posterior Tibial Slope (PTS), as well as functional scores at the final follow-up—the Hospital for Special Surgery Knee Score (HSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Forgotten Joint Score-12 (FJS-12). The assessment of knee instability was primarily based on patients' reports of giving way, buckling, or a sense of instability during daily activities, as recorded in follow-up interviews. Standardized physical stress tests for instability were not routinely performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWiberg classification\u003c/strong\u003e: There are two physicians evaluated the patella using 90° axial X-ray films, knee CT scans\u0026nbsp;and MRI images according to the Wiberg classification system. Wiberg Type I: Both medial and lateral patellar articular surfaces are essentially symmetrical (I); Wiberg Type II: The lateral articular surface is larger than the medial one (Group II); Wiberg Type III: The medial articular surface is extremely small or absent (Group III)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSatisfaction Assessment:\u003c/strong\u003e A 5-point Likert scale (very satisfied, satisfied, neutral, dissatisfied, very dissatisfied) was used. Responses of \"very satisfied\" and \"satisfied\" were defined as \"satisfied\"; \"neutral,\" \"dissatisfied,\" and \"very dissatisfied\" were defined as \"dissatisfied.\"\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was performed using SPSS 26.0. Continuous variables are presented as mean ± standard deviation. After normality was confirmed by the Shapiro-Wilk test, intergroup comparisons were made using the t-test, reporting effect size (d value) and 95% confidence interval (CI). Categorical variables are presented as number (percentage). Intergroup comparisons were made using the χ² test, reporting association strength (φ coefficient or Cramer's V). Variables with P\u0026lt;0.05 in the univariate analysis were included in a binary logistic regression model for multivariate analysis. Categorical variables were treated as dummy variables. The \"Enter\" method was used for model building. Odds ratios (OR) and their 95% CIs are reported. A P-value \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatient Satisfaction Distribution and Overview\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 978 patients were included. Among them, 811 (82.9%) were satisfied with the treatment outcome, and 167 (17.1%) were dissatisfied. Effect size analysis indicated large effects for the HSS score (d=3.54) and WOMAC score (d=1.04). Stair-related pain (φ=0.44), walking pain (φ=0.34), and the ability to kneel fully (φ=0.36) showed medium effect sizes, constituting the main clinical symptoms and functional limitations contributing to dissatisfaction. Age also showed a medium effect size (φ=0.27), indicating significantly higher satisfaction among elderly patients (\u0026gt;60 years).\u003cstrong\u003e(Table.1)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of General Characteristics Between Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnivariate analysis revealed significant differences (P\u0026lt;0.05) between the groups in the following variables: \u003cstrong\u003ePatellar Wiberg classification\u003c/strong\u003e (χ² = 9.284, p=0.01, Cramer's V =0.097): Type III was associated with the highest dissatisfaction rate. \u003cstrong\u003eProsthesis type\u003c/strong\u003e (χ² = 19.03, p\u0026lt;0.001, Phi φ = 0.139): Satisfaction was significantly higher in the mobile-bearing group. \u003cstrong\u003eSurgeon\u003c/strong\u003e (χ² =9.284, p=0.01, Cramer's V =0.097): Patient satisfaction varied among different surgeons, with one surgeon's group showing the highest satisfaction proportion. \u003cstrong\u003eAge\u003c/strong\u003e (χ² =70.732, p\u0026lt;0.001, Phi φ = 0.269): Satisfaction was significantly higher in patients \u0026gt;60 years old.\u003cstrong\u003e(Table.2)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnee Function Outcome Indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSignificant differences were found between the satisfied and dissatisfied groups in: \u003cstrong\u003eAbility to kneel fully\u003c/strong\u003e (χ² =123.456, p\u0026lt;0.001, Phi φ =0.355); \u003cstrong\u003eStair-related pain\u003c/strong\u003e (χ² =185.001, p\u0026lt;0.001, Phi φ =0.435); \u003cstrong\u003eWalking pain\u003c/strong\u003e (χ² =110.832, p\u0026lt;0.001, Phi φ =0.337); \u003cstrong\u003eKnee instability\u003c/strong\u003e (χ² =48.869, p\u0026lt;0.001, Phi φ=0.224). Furthermore, the dissatisfied group had a significantly \u003cstrong\u003ehigher WOMAC score\u003c/strong\u003e (t =-13.233, p\u0026lt;0.001, 95% CI: -14.142, -8.799, d=1.04) and significantly \u003cstrong\u003elower HSS score\u003c/strong\u003e (t=46.859, p\u0026lt;0.001, 95% CI: 4.855, 6.682, d=3.54) and \u003cstrong\u003eFJS-12 score\u003c/strong\u003e (t =4.304, p\u0026lt;0.001, 95% CI: 0.966, 2.586, d=0.35). The dissatisfied group also had a significantly \u003cstrong\u003esmaller HKA angle\u003c/strong\u003e (t=4.167, p\u0026lt;0.001, 95% CI: 0.318, 1.039, d=0.33).\u003cstrong\u003e(Table.1)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOther Indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo statistically significant associations (all p\u0026gt;0.05) were found between satisfaction and the following: gender, operative side, education level, posterior tibial slope, symptom duration, follow-up time, body mass index (BMI), or American Society of Anesthesiologists (ASA) physical status classification.\u003cstrong\u003e(Table.1\u0026amp;2)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of Patient-Reported Postoperative Symptoms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most commonly reported postoperative symptoms, in descending order of frequency, were: stair-related pain, walking pain, knee instability, and lateral compartment pain.\u003cstrong\u003e(Fig.2)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariate Logistic Regression Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVariables with P\u0026lt;0.05 in the univariate analysis were entered into the multivariate logistic regression model. The results identified the following as independent risk factors for dissatisfaction after UKA: \u003cstrong\u003eKneeling ability\u003c/strong\u003e (OR=0.128, 95%CI: 0.079-0.206),\u003cstrong\u003eWalking\u003c/strong\u003e\u003cstrong\u003epain\u003c/strong\u003e(OR=9.463,95%CI:5.591-16.014), \u003cstrong\u003eKnee instability\u003c/strong\u003e(OR=3.988, 95%CI:2.179-7.298), and \u003cstrong\u003eStair-related pain\u003c/strong\u003e(OR=8.783, 95%CI:5.588-13.803). Notably, an OR\u0026lt;1 for kneeling ability indicates that \u003cstrong\u003ebeing able to kneel fully is a strong protective factor for satisfaction\u003c/strong\u003e (OR=0.128).\u003cstrong\u003e(Table.3)\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBased on the analysis of clinical data from 978 UKA patients, this study found a postoperative satisfaction rate of 82.9%. This figure provides a benchmark specifically focused on the efficacy of unilateral surgery. We excluded patients who underwent bilateral UKA to ensure the independence of the unilateral assessment, thereby avoiding confounding bias in satisfaction evaluation due to functional interaction between both knees. This methodological choice may partly explain the observed satisfaction rate in our study compared to some research that included bilateral cases. Dissatisfaction following UKA was closely associated with factors including the surgeon, prosthesis type, patellar morphology, age, kneeling ability, stair-related pain, walking pain, and knee instability. Most importantly, multivariate analysis identified kneeling difficulty, stair-related pain, walking pain, and knee instability as independent risk factors for dissatisfaction.Our univariate analysis revealed significant variation in satisfaction rates among surgeons, with Surgeon A’s cohort demonstrating the highest proportion of satisfied patients (Table 2). While this study was not designed to compare specific technical nuances, possible contributing factors may include differences in surgical approach, soft-tissue balancing technique, implant positioning preferences, or volume of UKA performed. Further prospective studies with standardized technique documentation are needed to elucidate which technical aspects most strongly influence patient-reported outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Influence of Surgical Technique and Prosthesis on Satisfaction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch has identified inherent varus deformity in 17% of female and 32% of male patients in Asian populations, with studies suggesting that mild varus alignment post-total knee arthroplasty (TKA) may correlate with better functional outcomes\u0026nbsp;[10],For medial UKA, a postoperative varus alignment of 1-4° is associated with optimal functional results and implant survival[11].This is supported by the work of Slaven et al., who reported that well-functioning UKA patients demonstrated approximately 4° of mild varus mechanical alignment at a 10-year follow-up[12],In our study, the dissatisfied group exhibited a smaller hip-knee-ankle (HKA) angle, a difference that was statistically significant but with a low effect size, and this variable was not an independent factor in the multivariate analysis. This suggests a complex and potentially non-linear relationship between lower limb alignment and patient satisfaction, warranting further investigation.While 85% of osteoarthritis cases primarily involve the medial compartment[3],the disease process often represents a broader degenerative progression. Consequently, after addressing the medial compartment, abnormal pressure changes in the lateral compartment become a critical factor affecting overall knee contact stress and serve as a biomechanical basis for postoperative pain and instability[13],Therefore, within the boundaries of established indications for UKA[14], achieving a patient-specific, moderate alignment correction may be more conducive to enhancing satisfaction.Our results (Table 2) revealed significant variation in patient satisfaction among different surgeon groups, a finding consistent with arthroplasty registry data highlighting the importance of surgical experience and procedural volume on UKA outcomes[15, 16]This highlights that both case volume accumulation and progression along the learning curve are equally important for improving surgical outcomes. Prosthesis stability is crucial for activities requiring high degrees of knee flexion, such as deep squatting. Previous studies have confirmed that with meticulous surgical technique, Asian patients can achieve good functional results following medial UKA.[17]. Our study observed that satisfaction and perceived range of motion were lower with fixed-bearing prostheses compared to mobile-bearing designs. This may be attributed to the mobile-bearing design philosophy, which more closely replicates natural knee kinematics and has been associated with favorable long-term wear characteristics in biomechanical studies[18]. However, the direct link between polyethylene wear and early patient satisfaction remains uncertain.Furthermore, studies indicate that fixed-bearing UKA may increase lateral compartment pressure, whereas mobile-bearing designs better approximate physiological knee loading[19],\u0026nbsp;However, given the retrospective nature of our study, the choice of prosthesis may have been subject to selection bias based on patient indications. This observation requires validation through prospective studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInfluence of Patient Factors on Satisfaction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe impact of age on postoperative satisfaction following UKA is multifaceted. The univariate analysis in this study indicated that younger patients (age ≤ 60 years) reported significantly lower satisfaction than their older counterparts (age \u0026gt; 60 years), a finding consistent with some existing literature. For instance, Kleeblad et al.\u0026nbsp;[20]observed that among UKA patients satisfied with their ability to return to sports, the satisfaction rate was higher in the 70-year-old age group (93.1%) compared to the 55-year-old group (77.8%). A meta-analysis also suggested that early return to physical activity postoperatively may be associated with better outcomes[21]. However, in the multivariate analysis of our study, age was not identified as an independent risk factor for dissatisfaction (P=0.294). This suggests that the lower satisfaction observed in younger patients may not be directly attributable to age \u003cem\u003eper se\u003c/em\u003e, but rather mediated indirectly through other age-correlated factors. Younger patients typically have higher activity levels and greater functional expectations[22], which may render them more sensitive to residual postoperative pain or functional limitations (such as stair-related or walking pain), thereby reducing their overall satisfaction. In other words, age likely serves as a surrogate marker for patient expectations and activity demands, whereas satisfaction is more directly influenced by the achievement of the specific functional states corresponding to those expectations.Concerning body mass index (BMI), traditional perspectives, such as the Scott criteria, often regard severe obesity (e.g., BMI \u0026gt; 35-40) as a relative contraindication for UKA, primarily due to concerns about implant survival under high mechanical loads. Our findings align with recent studies[23, 24].Showing no significant association between BMI and patient-reported satisfaction in the early postoperative period. This indicates that UKA remains an effective treatment option for obese patients in terms of pain relief and functional improvement. Nevertheless, clinicians should thoroughly inform these patients about the potential long-term risks of increased wear and higher revision rates during preoperative counseling.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of Core Symptoms and Functional Limitations Influencing Satisfaction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComplications following unicompartmental knee arthroplasty, such as implant loosening, wear, dislocation, and infection, are critical factors affecting long-term outcomes and implant survival, with aseptic loosening being a leading cause of revision[25]. However, this study suggests that early subjective patient dissatisfaction is more directly driven not by these traditional major complications, but by a constellation of clinical symptoms dominated by pain and functional impairments. Multivariate analysis identified \u003cstrong\u003ewalking pain\u003c/strong\u003e (OR=9.463), \u003cstrong\u003estair-related pain\u003c/strong\u003e (OR=8.783), \u003cstrong\u003eknee instability\u003c/strong\u003e (OR=3.988), and \u003cstrong\u003erestricted kneeling ability\u003c/strong\u003e (OR=0.128) as independent risk factors for dissatisfaction. The exceptionally high odds ratios for the various pain symptoms designate them as the strongest predictors of dissatisfaction.The etiology of these pain symptoms is diverse. Early postoperative pain may be related to surgical trauma, soft tissue inflammation, or the rehabilitation process. In contrast, persistent or new-onset pain in the mid- to long-term should raise suspicion for disease progression in the contralateral compartment or the patellofemoral joint. Our findings support the view that degeneration of the lateral compartment and the patellofemoral joint constitutes a significant source of postoperative pain[26]. The biomechanical rationale is that while UKA addresses the pathology and alignment of the medial compartment, it may alter the overall stress distribution across the knee. If pre-existing early degeneration in the lateral or patellofemoral compartments or underlying limb malalignment is present, the postoperative redistribution of joint loads may accelerate the pathological process in these areas, manifesting as pain during walking or stair climbing. Therefore, postoperative pain is not only a direct cause of dissatisfaction but may also serve as a clinical indicator of altered biomechanics or disease progression in other compartments of the knee.Beyond pain, the inability to achieve a full kneeling posture postoperatively emerged as a potent independent risk factor for dissatisfaction. This is far more than a simple functional metric; it carries significant biomechanical implications and reflects culturally specific activities of daily living. From a biomechanical perspective, achieving a comfortable kneeling posture requires deep knee flexion, often exceeding 130°-150°, and places high demands on patellofemoral and tibiofemoral joint coordination, quadriceps strength, and soft tissue balance[27]. Difficulty kneeling after UKA may indicate several issues: (1) prosthesis design or placement limiting maximum flexion, particularly due to posterior tibial component or polyethylene insert impingement; (2) abnormal patellofemoral tracking or progressive degeneration; or (3) postoperative capsular or soft tissue contracture leading to loss of deep flexion. Thus, 'the ability to kneel' serves as a high-order functional marker, reflecting surgical precision, prosthesis performance, and the state of the patellofemoral joint. Culturally, for the study population—which includes a significant number of Hui ethnic individuals—and many Asian communities, kneeling is essential for daily activities (e.g., domestic chores, sitting) and religious practices. This deeply ingrained functional need directly shapes patients' postoperative expectations and their definition of surgical success, a notion supported by prior research linking high-flexion activities to satisfaction[28]Our study further identified a significant association between preoperative patellar morphology and both postoperative kneeling ability and satisfaction. Univariate analysis showed the highest dissatisfaction rate among patients with Wiberg type III patellae. This can be explained anatomically and biomechanically. The type III patella is characterized by a prominent lateral facet, a very small medial facet, and a medially displaced central ridge[29]. This morphology leads to abnormally concentrated contact stress on the lateral patellofemoral joint, predisposing to excessive lateral pressure syndrome (ELPS) and severe cartilage wear\u0026nbsp;[30]. Concomitant changes in the Q-angle may further exacerbate patellar maltracking. Additionally, the type III patella is more prone to \"tendofemoral contact\" (contact between the patellar tendon and femur) during deep flexion, possibly an adaptive change to reduce focal cartilage pressure, but one that inherently limits high-flexion capacity. Consequently, patients with type III patellae are likely to encounter greater difficulty and discomfort during postoperative activities requiring deep flexion or high stress, such as stair climbing or kneeling. This persistent functional limitation, by impairing daily and culturally specific activities, indirectly lowers overall satisfaction. This underscores the importance of identifying Wiberg type III patellae during preoperative UKA assessment. Research suggests that correcting abnormal patellar morphology through techniques like patelloplasty may improve patellofemoral biomechanics and enhance postoperative functional outcomes and satisfaction[31]Finally, knee instability was also an independent factor for dissatisfaction. Although its OR was lower than that for pain symptoms, it warrants attention. The sensation of instability, which may stem from suboptimal ligament balance, improper implant positioning, or progressive joint laxity, can undermine patient confidence during activities, especially when turning or walking on uneven surfaces.\u003c/p\u003e\n\u003cp\u003eBased on this analysis, we propose that for patients with demands for deep flexion, preoperative assessment should include detailed inquiry into functional expectations and evaluation of patellar Wiberg classification. Intraoperatively, efforts should focus on achieving optimal implant matching, alignment restoration, and ligament balance, avoiding overstuffing or excessive tightness in the flexion gap. Postoperative rehabilitation should incorporate progressive deep flexion and stability training. Future prospective studies are needed to validate whether such a personalized surgical and rehabilitative approach, aimed at alleviating core symptoms and restoring specific functional needs, can systematically enhance patient satisfaction.\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. First, as a single-center, retrospective study, it is susceptible to selection bias, and the identified associations do not establish causality between the factors and satisfaction. Second, satisfaction is a subjective measure that may be influenced by unmeasured patient expectations and psychological factors. Third, although we identified pain as a primary factor, we did not perform a stratified analysis of its specific etiologies (e.g., loosening, progressive arthritis). Finally, the conclusions are drawn from data of a single center in Northwest China, and their generalizability requires validation through multicenter studies. Future prospective research is needed to confirm these risk factors and explore targeted intervention strategies.\u003c/p\u003e\n\u003cp\u003eThis study confirms that satisfaction following UKA is primarily driven by residual postoperative symptoms and functional limitations, specifically walking pain, stair-related pain, knee instability, and kneeling difficulty. Kneeling difficulty is particularly significant within specific cultural contexts. The refinement of surgical technique (e.g., by experienced surgeons), optimization of prosthesis selection, and preoperative assessment of the patellofemoral joint status are also crucial for meeting patient expectations. Patients, especially those with high activity demands, should be thoroughly counseled preoperatively regarding these potential risks.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUnicompartmental Knee Arthroplasty UKA\u003c/p\u003e\n\u003cp\u003eKnee Osteoarthritis \u0026nbsp;KOA\u003c/p\u003e\n\u003cp\u003eTotal Knee Arthroplasty \u0026nbsp;TKA\u003c/p\u003e\n\u003cp\u003eBody Mass Index \u0026nbsp;BMI\u003c/p\u003e\n\u003cp\u003eHip-Knee-Ankle Angle \u0026nbsp;HKA\u003c/p\u003e\n\u003cp\u003ePosterior Tibial Slope \u0026nbsp;PTS\u003c/p\u003e\n\u003cp\u003eHospital for Special Surgery Knee Score \u0026nbsp;HSS\u003c/p\u003e\n\u003cp\u003eWestern Ontario and McMaster Universities Osteoarthritis Index \u0026nbsp; WOMAC\u003c/p\u003e\n\u003cp\u003eForgotten Joint Score-12 \u0026nbsp;FJS-12\u003c/p\u003e\n\u003cp\u003eAmerican Society of Anesthesiologists \u0026nbsp;ASA\u003c/p\u003e\n\u003cp\u003eOdds Ratio \u0026nbsp; OR\u003c/p\u003e\n\u003cp\u003eConfidence Interval \u0026nbsp; CI\u003c/p\u003e\n\u003cp\u003eExcessive Lateral Pressure Syndrome \u0026nbsp; \u0026nbsp;ELPS\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge all the collaborators and participants who contributed to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhang and C. Wang contributed equally as co-first authors, responsible for study conception, design, analysis, and manuscript drafting. Y. Liu contributed to data curation and formal analysis. D. Chen and Z. Bai contributed to investigation and data collection. Y. Liang supervised the project and provided critical revision. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis trial was partially funded by the Ningxia Health Commission (No. 2025-NWZC-B006). Ningxia Science and Technology Transformation Project 2025 (Application and promotion of remote precision medical system for hip and knee joints based on surgical robots：NO.2025CJE09011）The funding source did not play any role in the study design.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article and its supplementary information files.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Ningxia Hui Autonomous Region(Approval No.2025-WJW-004). Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eKnee Osteoarthritis: Assessment of Quality of Life in These Patients\u003c/strong\u003e. \u003cem\u003eAmerican Journal of Pure and Applied Biosciences \u003c/em\u003e2023:45-48.\u003c/li\u003e\n\u003cli\u003eLangworthy M, Dasa V, Spitzer AI: \u003cstrong\u003eKnee osteoarthritis: disease burden, available treatments, and emerging options\u003c/strong\u003e. \u003cem\u003eTherapeutic Advances in Musculoskeletal Disease \u003c/em\u003e2024, 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\u003c/em\u003e2020, \u003cstrong\u003e49\u003c/strong\u003e(4):1183-1198.\u003c/li\u003e\n\u003cli\u003eHan H-S, Kim JS, Lee B, Won S, Lee MC: \u003cstrong\u003eA high degree of knee flexion after TKA promotes the ability to perform high-flexion activities and patient satisfaction in Asian population\u003c/strong\u003e. \u003cem\u003eBMC Musculoskeletal Disorders \u003c/em\u003e2021, \u003cstrong\u003e22\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eRodolfo M-A, Caterina C, Christopher C-C, Gerardo C-J, Judith G-L, Carlos F O-G, Rodrigo E E-O, Santos G-L, Joan Carles M, Vicente S-A: \u003cstrong\u003eFemoral maltorsion influences both patellofemoral and tibiofemoral contact pressures. A biomechanical evaluation\u003c/strong\u003e. \u003cem\u003eJ ISAKOS \u003c/em\u003e2025, \u003cstrong\u003e12\u003c/strong\u003e(0).\u003c/li\u003e\n\u003cli\u003eLi M, Liu Q, Cui G: \u003cstrong\u003eLateral patellar tilting can also result in cartilage lesions of tibial plateau - the characteristic features of excessive lateral pressure syndrome: a retrospective study of 141 cases\u003c/strong\u003e. \u003cem\u003eBMC Musculoskelet Disord \u003c/em\u003e2025, \u003cstrong\u003e26\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eYing-Jin S, Ning L, Long H, Xiang-Yang C, Cheng L, Shuo F: \u003cstrong\u003eThe influence of patellar morphology on clinical outcomes after unicompartmental knee arthroplasty\u003c/strong\u003e. \u003cem\u003eInt Orthop \u003c/em\u003e2024, \u003cstrong\u003e48\u003c/strong\u003e(12).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 Comparison of continuous data between two groups of patients\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"524\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.374%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.6107%;\"\u003e\n \u003cp\u003esatisfied（811）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.0305%;\"\u003e\n \u003cp\u003edissatisfied（167）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8321%;\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3588%;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.7939%;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.374%;\"\u003e\n \u003cp\u003eFollow-up time（months）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.6107%;\"\u003e\n \u003cp\u003e49.32\u0026plusmn;19.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.0305%;\"\u003e\n \u003cp\u003e50.76\u0026plusmn;17.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8321%;\"\u003e\n \u003cp\u003e-0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3588%;\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.7939%;\"\u003e\n \u003cp\u003e-4.671,1.786\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.374%;\"\u003e\n \u003cp\u003eSymptom duration（months）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.6107%;\"\u003e\n \u003cp\u003e6.12\u0026plusmn;2.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.0305%;\"\u003e\n \u003cp\u003e5.99\u0026plusmn;3.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8321%;\"\u003e\n \u003cp\u003e0.542\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3588%;\"\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.7939%;\"\u003e\n \u003cp\u003e-0.346,0.611\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.374%;\"\u003e\n \u003cp\u003eWOMAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.6107%;\"\u003e\n \u003cp\u003e47.22\u0026plusmn;15.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.0305%;\"\u003e\n \u003cp\u003e65.46\u0026plusmn;19.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8321%;\"\u003e\n \u003cp\u003e-13.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3588%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.7939%;\"\u003e\n \u003cp\u003e-14.142,-8.799\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.374%;\"\u003e\n \u003cp\u003eHSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.6107%;\"\u003e\n \u003cp\u003e89.83\u0026plusmn;5.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.0305%;\"\u003e\n \u003cp\u003e67.98\u0026plusmn;7.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8321%;\"\u003e\n \u003cp\u003e46.859\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3588%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.7939%;\"\u003e\n \u003cp\u003e4.855,6.682\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.374%;\"\u003e\n \u003cp\u003eFJS-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.6107%;\"\u003e\n \u003cp\u003e78.22\u0026plusmn;4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.0305%;\"\u003e\n \u003cp\u003e76.45\u0026plusmn;5.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8321%;\"\u003e\n \u003cp\u003e4.304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3588%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.7939%;\"\u003e\n \u003cp\u003e0.966,2.586\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.374%;\"\u003e\n \u003cp\u003eHKA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.6107%;\"\u003e\n \u003cp\u003e174.22\u0026plusmn;2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.0305%;\"\u003e\n \u003cp\u003e173.54\u0026plusmn;1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8321%;\"\u003e\n \u003cp\u003e4.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3588%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.7939%;\"\u003e\n \u003cp\u003e0.318,1.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.374%;\"\u003e\n \u003cp\u003ePJS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.6107%;\"\u003e\n \u003cp\u003e8.61\u0026plusmn;2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.0305%;\"\u003e\n \u003cp\u003e8.62\u0026plusmn;2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.8321%;\"\u003e\n \u003cp\u003e-0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.3588%;\"\u003e\n \u003cp\u003e0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.7939%;\"\u003e\n \u003cp\u003e-0.381,0.376\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 Comparison of categorical variables between two groups of patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"505\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003esatisfied（811）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003edissatisfied（167）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003egender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e228(28.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e48(28.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.869\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e583(71.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e119(71.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 96px;\"\u003e\n \u003cp\u003ewiberg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e280(34.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e42(25.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 59px;\"\u003e\n \u003cp\u003e13.596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e420(51.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e85(50.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e111(13.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e40(23.95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003eside\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eright\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e481（59.31%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e86（51.48%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003e3.469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eleft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e330（40.69%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e81（48.52%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003eProsthesis type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003efixed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e476(58.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e116(69.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003e6.721\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003emovable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e335(41.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e51(30.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003ejunior school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e708(87.30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e146(87.42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.969\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eHigh school and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e103(12.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e21(12.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 96px;\"\u003e\n \u003cp\u003esurgeon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003ea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e358（44.14%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e20（11.98%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 59px;\"\u003e\n \u003cp\u003e42.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e117（14.43%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e62（37.12%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003ec\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e138（17.02%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e45（26.95%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003ed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e198（24.41%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e40（23.95%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003eAge（year）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026gt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e573（70.65%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e61（36.53%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003e70.732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026le;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e238（29.35%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e106（63.47%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 96px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e262（32.31%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e63（37.72%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 59px;\"\u003e\n \u003cp\u003e3.725\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eoverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e421（51.91%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e73（43.72%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eObese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e128（15.78%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e31（18.56%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003ekneeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e546（67.32%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e35（20.96%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003e123.456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e265（32.68%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e132（79.04%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003eStair-related pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e102（12.58%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e99（59.28%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003e185.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e709（87.42%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e68（40.72%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003eWalking pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e84（10.36%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e72（43.11%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003e110.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e727（89.64%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e95（56.89%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003eKnee Instability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e58（7.15%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e42（25.15%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003e48.869\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e753（92.85%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e125（74.85%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e600（73.98%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e116（69.46%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003e1.444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e211（26.02%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e51（30.54%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3 Logistic regression analysis results\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"513\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.783\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.496,1.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ekneeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.079,0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eknee instability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.988\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.179,7.298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eStair-related pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.783\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.588,13.803\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ewalking pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.591,16.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Unicompartmental Knee Arthroplasty, Patient Satisfaction, Pain, Logistic Regression Analysis","lastPublishedDoi":"10.21203/rs.3.rs-8767610/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8767610/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMedial compartment knee osteoarthritis is common. Unicompartmental knee arthroplasty (UKA) offers a bone-preserving alternative to total knee replacement. Despite its advantages, patient dissatisfaction remains a concern, impacting perceived success beyond implant survival rates. Current evidence lacks a focused analysis of the specific factors driving patient dissatisfaction after UKA, particularly regarding residual symptoms and functional limitations. This study aimed to identify the key independent risk factors for dissatisfaction following UKA.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on the clinical data of patients who underwent UKA in the Department of Joint Surgery, Ningxia Hui Autonomous Region People's Hospital, between January 1, 2017, and December 31, 2023. Postoperative outcome data were collected via telephone and outpatient follow-up.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eUnivariate analysis revealed significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between the satisfied and dissatisfied groups regarding surgeon-related factors, prosthesis type, patellar Wiberg classification, age, kneeling ability, stair-related pain, walking pain, knee instability, HSS score, WOMAC score, and FJS score. No significant differences were found in operative side, gender, BMI, ASA grade, symptom duration, or posterior tibial slope. Multivariate logistic regression analysis identified kneeling difficulty, stair-related pain, walking pain, and knee instability as independent risk factors for dissatisfaction.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMultivariate analysis indicates that postoperative kneeling difficulty, stair-related pain, walking pain, and knee instability are independent risk factors for patient dissatisfaction. Additionally, factors related to the surgeon (as evidenced by inter-surgeon variation in outcomes), prosthesis type, and preoperative patellar morphology were also associated with satisfaction levels.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eIt is a retrospective registered, no registration was performed.\u003c/p\u003e","manuscriptTitle":"Identifying Predictors of Unsatisfactory Outcomes After Unicompartmental Knee Arthroplasty: A Retrospective Cohort Analysis of 978 Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-13 07:14:56","doi":"10.21203/rs.3.rs-8767610/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-09T16:46:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-29T19:27:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-27T07:23:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-23T10:59:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-20T11:53:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T12:40:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T02:22:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T09:00:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T03:21:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"130263355468489183946795960854821732704","date":"2026-03-09T16:44:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"99759106909123121044909172648782442549","date":"2026-03-09T01:50:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"187087172149776711121525992988378490921","date":"2026-03-08T18:35:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162557141544790798419053107011446747054","date":"2026-03-06T15:07:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"219094279262029845735563062919008706803","date":"2026-03-06T12:39:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"157444589395272148289925347741811134964","date":"2026-03-06T09:56:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"117346189618589376296223904433647601573","date":"2026-03-06T09:09:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"274711879792796708778862953382321721099","date":"2026-03-06T08:42:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"257368405767023925621745569319952093031","date":"2026-03-06T08:19:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-06T08:11:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-06T08:06:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-04T15:16:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-27T22:05:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2026-02-27T15:53:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e03aa2d1-65d8-4519-9025-09c374febf0c","owner":[],"postedDate":"March 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T10:53:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-13 07:14:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8767610","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8767610","identity":"rs-8767610","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}