Patient expectations of arthroplasty of the hip and knee

Abstract

Patient expectations and their fulfilment are an important factor in determining patient-reported outcome and satisfaction of hip (THR) and knee replacement (TKR). The aim of this prospective cohort study was to examine the expectations of patients undergoing THR and TKR, and to identify differences in expectations, predictors of high expectations and the relationship between the fulfilment of expectations and patient-reported outcome measures. During the study period, patients who underwent 346 THRs and 323 TKRs completed an expectation questionnaire, Oxford score and Short-Form 12 (SF-12) score pre-operatively. At one year post-operatively, the Oxford score, SF-12, patient satisfaction and expectation fulfilment were assessed. Univariable and multivariable analysis were performed. Improvements in mobility and daytime pain were the most important expectations in both groups. Expectation level did not differ between THR and TKR. Poor Oxford score, younger age and male gender significantly predicted high pre-operative expectations (p < 0.001). The level of pre-operative expectation was not significantly associated with the fulfilment of expectations or outcome. THR better met the expectations identified as important by patients. TKR failed to meet expectations of kneeling, squatting and stair climbing. High fulfilment of expectation in both THR and TKR was significantly predicted by young age, greater improvements in Oxford score and high pre-operative mental health scores. The fulfilment of expectations was highly correlated with satisfaction.

Measuring Expectations in Orthopaedic Surgery: A Systematic Review

“…The experience with the MOD-EMS initiative provided important lessons in terms of developing simple and user-friendly data collection methods, minimizing participant time burden, including rigorous quality control measures, and planning for financial sustainability, which are now being applied to the American Joint Replacement Registry [56]. However, the use of the HSS Expectation Surveys has recently been reported in several clinical studies from nonoriginating investigators [17,24,58,63], which may potentially allow for comparison of patient expectations and their association with other clinical variables between different populations and studies. Additionally, the recent inclusion of an expectations domain in the New Knee Society Score further promises to expand opportunities for the investigation of this variable in patients undergoing TKA [48,59].…”

“…Combined, these factors substantially limit surgeons' and researchers' ability to critically appraise and compare the published studies to date. With the relationship between fulfillment of patient expectations and increased satisfaction well documented [4,8,47,58,60], these factors may ultimately be restricting opportunities for maximizing patient satisfaction after orthopaedic care. For these reasons, leadership from the orthopaedic community is needed to encourage the use of a limited number of high-quality, standardized instruments for the measurement of patient expectations.…”

“…However, as experience with elective orthopaedic procedures has grown and the populations deemed to be candidates for surgery have expanded [7], defining successful surgery similarly has evolved, most notably with greater weight attached to patient-reported outcomes and satisfaction [49]. Several authors have reported strong associations between fulfillment of patient expectations of orthopaedic surgery and postoperative satisfaction [4,8,47,58,60]. This has led to increasing interest among surgeons and researchers in better defining and understanding patients' expectations of orthopaedic procedures with a goal of optimizing patient selection and preoperative education to ultimately influence patient satisfaction.…”

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

“…145,146 We identified two single-centre studies that had explored the relationship between pre-operative pain levels and long-term patient-reported outcomes after THR. 103,134 Details of studies are shown in Table 4.…”

Guided Imagery for Total Knee Replacement: A Randomized, Placebo-Controlled Pilot Study

“…15,27,[43][44][45][46][47][48][49] For example, in a study of 102 patients undergoing total hip replacement, patients' perioperative emotional state was a stronger predictor of functional status 6 months after surgery than was degree of surgical trauma. 43 Moreover, in a study of 952 patients who underwent TKR, preoperative psychological distress was associated with greater postoperative pain for up to 2 years.…”