Expectations of younger patients concerning activities after knee arthroplasty: are we asking the right questions?

Abstract

PurposeIndications for total and unicondylar knee arthroplasty (KA) have expanded to younger patients, in which Patient-Reported Outcome Measures (PROMs) often show ceiling effects. This might be due to higher expectations. Our aims were to explore expectations of younger patients concerning activities in daily life, work and leisure time after KA and to assess to what extent PROMs meet and evaluate these activities of importance.MethodsFocus groups were performed among osteoarthritis (OA) patients <65 years awaiting KA, in which they indicated what activities they expected to perform better in daily life, work and leisure time after KA. Additionally, 28 activities of daily life, 17 of work and 27 of leisure time were depicted from seven PROMS, which were rated on importance, frequency and bother. A total score, representing motivation for surgery, was also calculated.ResultsData saturation was reached after six focus groups including 37 patients. Younger OA patients expect to perform better on 16 activities after KA, including high-impact leisure time activities. From the PROMs, daily life and work activities were rated high in both importance and motivation for surgery, but for leisure time activities importance varied highly between patients. All seven PROMs score activities of importance, but no single PROM incorporates all activities rated important.ConclusionYounger patients expect to perform better on many activities of daily life, work and leisure time after KA, and often at demanding levels. To measure outcomes of younger patients, we suggest using PROMs that include work and leisure time activities besides daily life activities, in which preferably scored activities can be individualized.

Changes in Expectation Fulfillment Following Total Knee Arthroplasty: A 10-Year Follow-Up Study

“…Previous studies have noted that younger patients (<65 years) tend to have lower levels of satisfaction, despite excellent PROMs scores, up to 1 year following TKA [28,29]. Witjes et al [30] identified that younger patients tended to have expectations to perform multiple activities better following TKA, and that no commonly utilized PROM scoring systems adequately covered all that were considered important. The OKS may under-estimate the significance of certain activities to young patients and therefore over-state the quality of outcome achieved via a ceiling effect.…”

Translation, cross-cultural adaptation, and validation of the Italian language Forgotten Joint Score-12 (FJS-12) as an outcome measure for total knee arthroplasty in an Italian population

“…Consequently, increased patient expectations and improved outcomes have been reported [5]. Therefore, instruments which seek to measure outcomes after TKA must adapt to meet the changing expectations [6,7].…”

Patients return to work sooner after unicompartmental knee arthroplasty than after total knee arthroplasty

“…TKA does allow carrying out some knee-burdensome work activities, but a considerable percentage of TKA patients reported impaired ability to work and that they were dissatisfied with their level of ability to work. This is important as active work participation is an important factor in enhancing patients' quality of life and it gives structure to day-to-day life [47].…”