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.
Highlights
Patient'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
Further models suggest that the actual post-treatment status with regards to TKA: total knee arthroplasty
Thirteen out of the 112 patients with baseline data and 2-year follow-up data had undergone some sort of further surgery on the same knee, between 1 month and 21 months after the index surgery. This group recorded significantly worse 2year global outcomes (P = 0.003) and satisfaction grades (P = 0.012) than the rest of the group - since these revisions could not have been anticipated at baseline, yet they may have had an influence on the overall outcome rating at 2 years, the data from this group were not included in the multivariable analyses of predictors of outcome
Summary
Patient'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. It is generally accepted that the outcome of total joint replacement should be assessed on the basis of imaging, technical results, and objective functional/physiological findings, and in relation to the patient's perception of the benefit gained, as regards domains of importance to them in their everyday life [1,2]. The most dominant model posits that expectations being met - that is, minimising the mismatch between prior expectations and the actual result - is the most important determinant [4,5]. Further models suggest that the actual post-treatment status with regards to TKA: total knee arthroplasty
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