Page 172 - The value of total hip and knee arthroplasties for patients

Chapter 9
If, despite all those efforts, preoperative prediction appears to be unsuccessful, more efforts must be put into the early detection of unsuccessful recovery soon after surgery and appropriate management thereafter.
Expectations and their fulfilment
One factor that is generally considered to be decisive for recovery after THA or TKA concerns patient expectations. In Chapter 4 we determined to what extent a broad range of expectations were fulfilled one year afterTKA andTHA.ForTKA and THA it was shown that expectations for the outcomes of surgery were in general very high, with most patients expecting to have large improvements or even return to their ‘normal’ level of ability.There were however some expectations that clearly stood out, concerning the relatively large proportion of patients that indicated that these expectations were not or insufficiently fulfilled. One possible intervention strategy may be to preoperatively better address these expectations, e.g. by improving preoperative education. Managing unrealistic preoperative expectations in general is also mentioned as a potentially effective intervention, however for that purpose more clarity about when expectations should be considered to be realistic or unrealistic is needed. In this respect, the observation that patients’ and surgeons’ expectations are not always aligned must be taken into account.10 In addition, our study also showed that for many activities, despite relatively large proportions of patients in whom expectations were not or insufficiently fulfilled, there were also quite many patients in whom the expectation for that same activity was even exceeded.These finding suggests that managing a patient’s preoperative expectations is a process that needs to be highly individualized.
Return to society – Work
Despite the increasing attention for functional recovery afterTHA orTKA, return to work is a relatively under researched area. Related to the raising pensionable age in many countries and to other societal factors, the proportion of people undergoing THA or TKA and have a paid job will increase. In the recently published ICHOM Standard Set for Hip & Knee Osteoarthritis work, based on theValue Based Health Care framework of Michael E. Porter and Elizabeth O.Teisberg, indeed work status is included.1 However, that set is not yet fully implemented in orthopaedic practice.
Our literature review in Chapter 7 showed that overall, the majority of patients who are employed before THA or TKA return to work postoperatively, a finding that is in line with the results of our clinical study in Chapter 8. In all, the literature on work
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