Page 67 - 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
quite similar to those yielding the most optimistic expectations in our study (ie, largest proportions“back to normal”and“much improved”).InTHA,this was most apparent for the items “improving the ability to stand,” “relief of daytime pain in the joint,” and “improving the ability to walk.” In the TKA group, similarities were seen for “relief of daytime pain in the joint” and “improving the ability to walk.”
Fulfillment of Expectations
Regarding the fulfillment of expectations, methodologically, our study is best 4 comparable to the study by Palazzo et al1, although that study included only patients
undergoing THA. That study found that expectations were frequently unmet for
cutting toenails (53%), putting on shoes (50%), improving sexual activity (50%), spor t
and exercises (39%), and being employed (43%).The proportions of patients with unmet expectations were also relatively high for using a cane (40%) and relieving night pain (42%). In our study, expectations were unmet less frequently, except for cutting toenails (38%) where similar proportions were seen.This discrepancy may be partly explained by differences in measurement of the postoperative expectation fulfillment. In the study by Palazzo et al, the main question and answering options were adapted to assess the improvement that patients obtained from the surgery in each domain:“To what extent have you obtained a relief or improvement as a result of THA in the following areas?” (from 0: not at all; to 4: completely).The answer “not at all” (scoring 0) was separated from the answer “this question does not apply” (scoring 5).Furthermore,it may be that in our study,preoperative expectations were less optimistic, and therefore expectations were easier met, although we cannot be conclusive about this as Palazzo did not present preoperative expectation data.
Nilsdotter et al5 showed that patients undergoing TKA were least satisfied with their sport and recreational function. In our study, the proportion of patients in whom expectation was not met for sport and recreational function was indeed large (35%), but similar proportions were seen for 11 other outcomes as well. Although a different methodology was used, Scott et al found that overall, in patients undergoing THA, expectations were fulfilled to a large extent, whereas TKA failed to meet more expectations, including those concerning kneeling, squatting, and stair climbing. The discrepancy between THA and TKA patients regarding the fulfillment of expectations is in line with the results of our study.
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