Page 57 - The value of total hip and knee arthroplasties for patients

Unfulfilled expectations after total hip and knee arthroplasty surgery: there’s a need for better preoperative patient information and education
Total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) have proven
to be successful surgical interventions for patients with hip or knee osteoarthritis.
Despite the overall favorable results, previous studies have estimated that between
7%-15% of THA1,2 and 11%-20%3-5 TKA patients are dissatisfied after sur ger y. Evidence
suggests that dissatisfaction is (at least partly) related to patients’ expectations that
are not fulfilled.6,7 Several studies have assessed fulfillment of patients expectations,
although the majority only assessed a small selection of items (eg, only expectations
regarding pain)1,4,5,8, while evidence shows that patients have a very wide range of expectations.9 4
Three studies included a range of expectations.1,5,8 Nilsdotter et al5 examined the relationship between expectations regarding the 5 different domains of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and postoperative ability in 102 patients undergoing
TKA. The results show that, in general, preoperative expectations were higher than the actual postoperative ability after 5 years. In particular, in the sports and recreation domain, there was a large discrepancy between what patients expected and what they truly achieved.
Scott et al8 examined the preoperative expectations and their postoperative fulfilment using the Hospital for Special Surgery (HSS) Hip Replacement and Knee arthroplasty Expectations Surveys10 in 346 patients who hadTHA and 323 patients who underwent TKA. These results show that overall, in patients undergoing THA, expectations were fulfilled to a large extent, whereas TKA failed to meet expectations concerning kneeling, squatting, and stair climbing. The results of this study are difficult to interpret as modified versions of the questionnaires and their scoring methods were used.
Using the HSS Hip arthroplasty Expectations Survey, Palazzo et al1 measured the preoperative expectations of 132 patients and their surgeons and the patient perceived fulfillment of expectations 1 year after THA surgery. Considering the fulfillment of expectations for each item individually, both patients’ and surgeons’ expectations were frequently unmet for cutting toenails, putting on shoes, sexual activity, sport and exercises, and being employed.The proportions of patients with unmet expectations were also high for using a cane and relieving night pain. The
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