Poor expectations of knee replacement benefit are associated with modifiable psychological factors and influence the decision to have surgery: A cross-sectional and longitudinal study of a community-based sample

Abstract

Objective Total knee arthroplasty (TKA) is a highly effective surgery, but is underutilized by some patient groups. This study determined factors associated with a person’s expectations with respect to pain and walking function following a TKA procedure, should they elect to undergo a TKA. Methods A total of 3542 people were studied with or at risk of knee osteoarthritis and enrolled in the community-based Osteoarthritis Initiative (OAI). Multivariable logistic regression analyses identified demographic, socioeconomic, osteoarthritis-related, joint replacement awareness, and psychological correlates as poor outcome expectations. Logistic regression determined if outcome expectation was associated with future knee arthroplasty utilization. Results Approximately 25% of the sample expected a poor outcome. Several factors were associated with poor pain outcome expectation, with the most powerful being African American race (Odds Ratio (OR) = 2.11, 95% CI = 1.69, 2.64) and an interaction between clinical depression symptoms and pain catastrophizing (OR = 3.17, 95% CI = 2.26, 4.44 when both were coded ‘yes’). Whether a person had knee OA did not affect expectations. Pain outcome expectations were strongly associated with future TKA utilization (OR = 4.9, 95% CI = 2.2, 11.1). Conclusion A variety of modifiable psychological factors impact people’s expectations of the extent of pain and walking difficulty following a potential future TKA. Expectations strongly predict future TKA utilization. Given the high prevalence of knee osteoarthritis, mass media educational interventions for the population may assist in better aligning expectations with evidence-based knee arthroplasty outcomes and lead to more appropriate utilization of an effective procedure.

Outcome Expectations of Total Knee Arthroplasty Patients: The Influence of Demographic Factors, Pain, Personality Traits, Physical and Psychological Status

“…The present study found no relation between preoperative knee pain or function scores and expectations. These findings reflect results from previous reports, where no relation of preoperative pain 9,30,31 and function scores 9,[30][31][32] with the height of expectations is described. Given the known strong relationship between pre-and postoperative pain and function scores, these findings question the realism of patient expectations.…”

Preoperative Expectations of Patients Undergoing Knee Surgery

“…Nevertheless, given that this is the first study to explore preoperative expectations in such an expansive group of knee surgery patients, we believe that the findings here can help identify possible new predictors of expectations in knee surgery. Whereas we did not find associations between expectations and sex or race, other studies have identified male sex 35 and non-African American race 36 as predictors of greater preoperative expectations in patients undergoing total hip and knee arthroplasty, respectively. Regarding function and general health, previous studies have revealed that patients with worse preoperative hip-specific and overall function had greater expectations of total hip arthroplasty, 35 and that patients with worse preoperative function and general health had greater expectations of total shoulder arthroplasty.…”

Racial and Ethnic Differences in the Experience and Treatment of Noncancer Pain

“…Racial and ethnic differences in pain expectations have been documented in several studies, largely indicating that poorer pain expectations are experienced by minority patients. For example, several studies have demonstrated that, compared with white patients, black or African-American patients have worse pain expectations from joint replacement surgery [118][119][120][121] and that these differences in expectations account for the race differences in willingness to undergo these surgical procedures [119,121]. Although most of the literature examining race differences in pain expectations has been conducted for joint arthroplasty, an additional study has examined race differences in pain management expectations in the emergency department.…”