The Influence of Previous Joint Arthroplasty on Fulfillment of Patients' Expectations of Subsequent Lumbar Surgery

Abstract

Introduction: Hip, knee, and lumbar spine surgeries are prevalent with arthroplasty often preceding lumbar surgery. The objective of this analysis was to ascertain whether previous arthroplasty was associated with patients' postlumbar surgery fulfillment of expectations. Methods: Identical systematically acquired data were pooled from 3 prospective studies that included assessments of preoperative expectations of lumbar surgery and 2-year postoperative assessment of fulfillment of expectations using a valid survey with points assigned for amount of improvement expected for symptoms and function. The proportion of expectations fulfilled was defined as total points for improvement received postoperatively divided by total points for improvement expected preoperatively (range 0 [no expectations fulfilled] to >1 [expectations surpassed]). Enrollment data included the expectations survey, demographic/clinical characteristics, Oswestry Disability Index (ODI) scores, and previous hip/knee arthroplasty. Postoperative data included follow-up expectations survey, ODI scores, and any spine complications. The proportion was the dependent variable in multivariable linear regression with demographic/clinical independent variables. Results: 1137 patients were included (mean age 59 years, 51% male); 993 (87%) did not have previous arthroplasty, and 144 (13%) had arthroplasty (51 hip only, 77 knee only, 16 both hip/knee). Patients with any arthroplasty had similarly high expectations compared with patients with no arthroplasty but lower proportion of expectations fulfilled (0.69 versus 0.76, P = 0.03). In multivariable analysis, variables associated with a lower proportion of expectations fulfilled were greater preoperative expectations (P < 0.0001), not working (P < 0.0001), positive depression screen (P = 0.0002), previous lumbar surgery (P < 0.0001), previous arthroplasty (P = 0.03), surgery on ≥3 vertebrae (P = 0.007), less preoperative-to-postoperative ODI improvement (P < 0.0001), and postoperative complications (P < 0.0001). Conclusions: After accounting for a spectrum of highly associated covariates, patients with previous arthroplasty still had less fulfillment of expectations of subsequent lumbar surgery. For patients with previous arthroplasty, surgeons should discuss potential differences between arthroplasty and lumbar surgery during preoperative evaluations and during shared postoperative assessments of the outcome.