Page 66 - The value of total hip and knee arthroplasties for patients

Chapter 4
Discussion
Overall, the proportions of patients whose expectations were fulfilled or exceeded were somewhat lower in the TKA than in the THA group. Our results showed that in the THA group, exceeded expectations were seen in >20% of the patients for 6 items. In TKA patients, >20% of patients had exceeded expectations for 8 items. Still, as depicted in Table 2, there were some items where a substantial propor tion (>30%) of patients had unfulfilled expectations, concerning “improvement in walking ability: long distances” (31%), “walking stairs” (33%), and “improve ability to cut toenails” (38%) in THA and “being able to kneel down” (44%) and “being able to squat” (47%) in TKA.
Preoperative Expectations
In this study, the preoperative expectations of patients on improvement in postoperative outcomes were higher inTHA than inTKA for most studied variables. Moreover, in the group of patients undergoing THA, the number of outcomes for which 60% of the patients or more reported that their preoperative expectations were fulfilled or exceeded was larger than that in the TKA group. In the THA group, the largest proportions of patients with unfulfilled expectations (>30%) were seen for the items “walking stairs” and “improve ability to cut toenails” (38%). In the TKA group,the largest proportions of patients (>30%) with unfulfilled expectations were observed for “improvement walking ability middle long distances (up to 1.5 km’s)” (40%), “being able to kneel down” (47%), and “being able to squat” (44%).
Our study clearly demonstrated that preoperatively, the outcome expectations of patients undergoing THA were more positive than those of patients undergoing TKA. This is in concordance with studies indicating that patients undergoing TKA have more challenging rehabilitation processes and worse mid and longterm outcomes compared withTHA.17 Nilsdotter et al5 reported thatTKA patients had higher expectations preoperatively for Activities of Daily Living functions compared with sport and recreational function and relief of pain. Our study shows the same results for TKA patients.
Although the expectation measurement approach by Scott et al8 differed from ours (in their study, patients scored the importance of each outcome rather than the actual outcome expectations), results are fairly similar.The items which were rated very important by the vast majority of patients in the study by Scott et al were
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