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.

Measuring Expectations in Orthopaedic Surgery: A Systematic Review

“…Thirteen different clinical assessment tools modified for the evaluation of expectations were identified (Table 3) [2, 13,15,19,23,25,33,39,40,43,44,46,61,65]. All of the modified instruments were designed for self-administration by patients.…”

“…All of the modified instruments were designed for self-administration by patients. Excluding the modified Total Hip Arthroplasty Outcome Evaluation Questionnaire [13,33,40,65], all of the instruments were only used in a single study identified in our review. Twenty studies used custom questionnaires developed by the authors to assess patient expectations without any explicit description of the methodology, rationale, or source instrument behind their development [3, 5, 10, 12, 14, 16, 20, 22, 27, 28, 30-32, 45, 52, 53, 57, 64, 66, 68].…”

Challenges in Outcome Measurement: Discrepancies Between Patient and Provider Definitions of Success

“…Numerous studies have documented that the immediate priority of patients undergoing joint arthroplasty is relief of pain, stiffness, and swelling. Almost all patients expect to perform the activities of daily life (ADLs) without limitation after surgery [19,29,39,41,45,50,53] and that their ability to perform these activities will improve postoperatively [29,41,53]. In these studies, the majority of patients also assumed that they would have vast improvements in their ability to complete activities requiring a high range of joint mobility, such as putting on shoes and socks (94%) and clipping toenails (88% and 93% in two studies looking at this end point) [29,41].…”

Prospective study of gait function before and 2years after total knee arthroplasty

“…Patients completed a questionnaire preoperatively and at 2-year follow-up based on the total hip arthroplasty outcome evaluation questionnaire of Katz et al [24] and adapted for the German language (for further details, see [25]). Only some items were used in the present study.…”