How do the expectations of patients compare with their surgeons regarding outcomes of periacetabular osteotomy?

Abstract

ABSTRACTOur objective was to determine the frequency and strength of agreement between patients and their surgeons on preoperative expectations of the outcomes of periacetabular osteotomy (PAO) surgery. We also sought to determine whether patient preoperative function and pain levels were associated with patients’ and surgeons’ expectations and to identify the motivating factors for patients to undergo PAO. Two surgeons and their combined 68 patients preoperatively completed 4-point Likert-scales rating their expectations of improvement in six domains representing different hip symptoms after surgery. Domains included pain, stiffness, locking, stability, walking ability and athletic ability. Concordance between patient and surgeon expectation was evaluated by the percent of exact and partial agreement. Correlation analyses were performed to investigate associations between expectations of improvement and patient factors. Exact agreement between patients and surgeons ranged from 18.2% (stiffness) to 55.9% (pain) and partial agreement between patients and surgeons ranged from 48.5% (stiffness) to 100% (pain). Patients with higher UCLA scores tended to have lower surgeon expectations of improving walking ability (r = −0.34; P = 0.007) but higher expectations for improved athletic ability (r = 0.25; P = 0.04), and surgeons anticipated more improvement in walking for patients with higher stiffness (r = 0.31, P = 0.01) and pain (r = 0.38, P = 0.002). Similarly, patients with higher Short Form-12 physical component summary had lower surgeon expectations of improvement in walking ability (r = −0.40, P = 0.002) and stiffness (r = −0.35, P = 0.006). In the most domains there was frequent discrepancy between patient and surgeon expectations, with patients being more optimistic than their surgeons in every domain. For the pain domain, patients and surgeons had similar expectations.