Determinants of satisfaction 1 year after total hip arthroplasty: the role of expectations fulfilment

Abstract

BackgroundBetween 7% and 15% of patients are dissatisfied after total hip arthroplasty (THA). To assess predictors and postoperative determinants of satisfaction and expectation fulfilment one year after (THA).MethodsBefore THA surgery, 132 patients from three tertiary care centres and their surgeons were interviewed to assess their expectations using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (THR survey). One year after surgery, patients (n = 123) were contacted by phone to complete a questionnaire on expectation fulfilment (THR survey), satisfaction, functional outcome (Womac), and health-related quality of life (SF 12). Univariate and multivariate analyses were performed.ResultsPreoperative predictors of satisfaction were a good mental wellbeing (adjusted OR 1.09 [1.02; 1.16], p = 0.01) and optimistic surgeons expectations (1.07 [1.01; 1.14], p = 0.02). The main postoperative determinant of satisfaction was the fulfilment of patient’s expectations (1.08 [1.04; 1.12], p < 0.001). Expectation fulfilment could be predicted before surgery by young age (regression coefficient −0.55 [−0.88; -0.21], p = 0.002), good physical function (−0.96 [−1.82; -0.10], p = 0.03) and good mental wellbeing (0.56 [0.14; 0.99], p = 0.01). Postoperative determinants of expectation fulfilment were functional outcome (−2.10 [−2.79; -1.42], p <0.001) and pain relief (−14.83 [−22.38; -7.29], p < 0.001).ConclusionTo improve patient satisfaction after THA, patients’ expectations and their fulfilment need to be carefully addressed. Patients with low mental wellbeing or physical function should be identified and specifically informed on expected surgical outcome. Surgeons’ expectations are predictive of satisfaction and information should aim to lower discrepancy between surgeons’ and patients’ expectations.

Incidence and Location of Pain in Young, Active Patients Following Hip Arthroplasty

“…Several studies have investigated the incidence and potential etiology of pain following both THA and SRA [6][7][8][9][10]18,21,23,28,[35][36][37][38][39]], yet information regarding the incidence, severity, and location of pain in young, active patients undergoing hip arthroplasty remains limited. With an evolving patient population placing higher functional demands on hip prostheses, it is critical to be able to counsel these patients on what to expect following hip arthroplasty as patient dissatisfaction is often attributed to unmet expectations [32,33]. Therefore, the purpose of this study was to use a visual pain diagram to determine the anatomic location, incidence, and severity of pain in young, active patients following THA and SRA.…”

“…We hypothesized that a large percentage of young, active patients following both THA and SRA would report the presence of persistent pain, with the incidence of thigh pain being increased in the THA cohort. As patient education remains a critical predictor of postoperative satisfaction [32,33], this information would be valuable in setting expectations in this population of patients who elect to undergo THA or SRA.…”

Can Preoperative Patient-reported Outcome Measures Be Used to Predict Meaningful Improvement in Function After TKA?

“…For the purpose of this study it was defined as a change in PROM score after TKA greater than the MCID, which may not be the most appropriate definition of success. This definition excludes patient satisfaction, a separate outcome that has been shown to be dependent on patient expectations and highly variable as a result of factors specific to each individual patient [31,37]. For this reason, patient satisfaction may be an unreliable metric to assess the impact of an intervention [37].…”

Diagnostic and therapeutic physical therapy approach of patients in risk of falling after the surgical operation of total hip replacement

“…Even though most of the patients express themselves as satisfied with the undergoing of the surgical procedure and mostly the course of their post-operative lives, recent studies have emerge pointing out that a group of patients, between 7% and 30%, were met with frustrating difficulties during their daily living 7,[8][9][10] . To be more precise these difficulties included, as they reported, "reduced functional ability" and "health-related quality of life" and they were associated with the occurrence of falling incidences 11,12 .…”