The role of patient expectations in predicting outcome after total knee arthroplasty

Abstract

IntroductionPatient's expectations are variably reported to influence self-rated outcome and satisfaction after medical treatment; this prospective study examined which of the following was the most important unique determinant of global outcome/satisfaction after total knee arthroplasty (TKA): baseline expectations; fulfilment of expectations; or current symptoms and function.MethodsOne hundred and twelve patients with osteoarthritis of the knee (age, 67 ± 9 years) completed a questionnaire about their expectations regarding months until full recovery, pain, and limitations in everyday activities after TKA surgery. Two years postoperatively, they were asked what the reality was for each of these domains, and rated the global outcome and satisfaction with surgery. Multivariable regression analyses using forward conditional selection of variables (and controlling for age, gender, other joint problems) identified the most significant determinants of outcome.ResultsPatients significantly underestimated the time for full recovery (expected 4.7 ± 2.8 months, recalled actual time, 6.1 ± 3.7 months; P = 0.005). They were also overly optimistic about the likelihood of being pain-free (85% expected it, 43% were; P < 0.05) and of not being limited in usual activities (52% expected it, 20% were; P < 0.05). Global outcomes were 46.2% excellent, 41.3% good, 10.6% fair and 1.9% poor. In multivariable regression, expectations did not make a significant unique contribution to explaining the variance in outcome/satisfaction; together with other joint problems, knee pain and function at 2 years postoperation predicted global outcome, and knee pain at 2 years predicted satisfaction.ConclusionsIn this group, preoperative expectations of TKA surgery were overly optimistic. The routine analysis of patient-orientated outcomes in practice should assist the surgeon to convey more realistic expectations to the patient during the preoperative consultation. In multivariable regression, expectations did not predict global outcome/satisfaction; the most important determinants were other joint problems and the patient's pain and functional status 2 years postoperatively.

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

“…However, fulfilment of expectations seemed to be predominantly associated with a better functional outcome, in accordance with previous literature findings [ 9 , 11 , 12 , 22 ]. Pain relief and limp absence were independent determinants of fulfilled expectations also.…”

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

“…However, fulfilment of expectations seemed to be predominantly associated with a better functional outcome, in accordance with previous literature findings [ 9 , 11 , 12 , 22 ]. Pain relief and limp absence were independent determinants of fulfilled expectations also.…”

Fulfilment of patient-rated expectations predicts the outcome of surgery for femoroacetabular impingement

“…Alone, these had no significant correlation with the ratings of GTO. This concurs with the findings from some previous studies on orthopaedic patients 30 , and especially those where multivariate models have been used to assess the relative importance of different predictors 23,31 . It would hence appear that simply 1.…”

Patients' expectations about total knee arthroplasty outcomes

“…Like others, we found pre‐operative characteristics to be important in the development of expectations of surgery . Our results are generally consistent with two previously published studies of expectations of TKA, one in Europe and the other one in Australia, in which patients also had high expectations of the outcome of the surgery . Our participants were optimistic, expecting to be able to perform usual daily activities within 6 weeks of surgery.…”

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

“…However, fulfilment of expectations seemed to be predominantly associated with a better functional outcome, in accordance with previous literature findings [ 9 , 11 , 12 , 22 ]. Pain relief and limp absence were independent determinants of fulfilled expectations also.…”

Fulfilment of patient-rated expectations predicts the outcome of surgery for femoroacetabular impingement

“…Alone, these had no significant correlation with the ratings of GTO. This concurs with the findings from some previous studies on orthopaedic patients 30 , and especially those where multivariate models have been used to assess the relative importance of different predictors 23,31 . It would hence appear that simply 1.…”

Patients' expectations about total knee arthroplasty outcomes

“…Like others, we found pre‐operative characteristics to be important in the development of expectations of surgery . Our results are generally consistent with two previously published studies of expectations of TKA, one in Europe and the other one in Australia, in which patients also had high expectations of the outcome of the surgery . Our participants were optimistic, expecting to be able to perform usual daily activities within 6 weeks of surgery.…”

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

“…However, fulfilment of expectations seemed to be predominantly associated with a better functional outcome, in accordance with previous literature findings [ 9 , 11 , 12 , 22 ]. Pain relief and limp absence were independent determinants of fulfilled expectations also.…”

Fulfilment of patient-rated expectations predicts the outcome of surgery for femoroacetabular impingement

“…Alone, these had no significant correlation with the ratings of GTO. This concurs with the findings from some previous studies on orthopaedic patients 30 , and especially those where multivariate models have been used to assess the relative importance of different predictors 23,31 . It would hence appear that simply 1.…”

Patients' expectations about total knee arthroplasty outcomes

“…Like others, we found pre‐operative characteristics to be important in the development of expectations of surgery . Our results are generally consistent with two previously published studies of expectations of TKA, one in Europe and the other one in Australia, in which patients also had high expectations of the outcome of the surgery . Our participants were optimistic, expecting to be able to perform usual daily activities within 6 weeks of surgery.…”