, Volume 471, Issue 1, pp 175-180
Date: 21 Jul 2012

Discordance in TKA Expectations Between Patients and Surgeons

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Aligning patient and surgeon expectations preoperatively may lead to better postoperative medical and rehabilitation compliance and therefore improve outcomes and increase satisfaction.


We (1) determined the rate of discordantly high patient expectations compared with those of their surgeon in patients undergoing TKA; and (2) evaluated the impact of the preoperative educational class, patient characteristics, and functional status on the likelihood of having discordantly high patient expectations.


We enrolled 205 patients awaiting TKA. Each patient completed a validated questionnaire that addresses expectations of postoperative pain relief, function, and well-being as part of a preoperative assessment. The surgeon completed the same expectations questionnaire preoperatively blinded to their patient’s response. Patients had discordantly high expectations if their scores were ≥ 7 points higher than the surgeon on a 0 to 100 score range. Regression analysis was performed to determine the effect of class, patient characteristics, and functional status on the likelihood of having discordantly high patient expectations.


Thirty-seven percent of the patients had expectation scores ≥ 7 points higher than those of their surgeon. Patients were less likely to have discordantly higher expectations if they were female (OR, 0.56; CI, 0.32–0.97) and if their pain level was high (OR, 0.99; CI, 0.98–0.99). Patients were more likely to have discordantly higher expectations if they filled out the expectations survey before rather than after the preoperative educational class (OR, 1.80; CI, 1.08–3.01).


With increasing TKA use, surgeons will likely encounter more patients with discordantly high expectations. The preoperative educational class can be used to target patients more likely to have discordantly high expectations.

Level of Evidence

Level I, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

The Expectations Discordance Study Group includes (in addition to the authors): David Mayman MD, Mathias Bostrom MD, Alejandro Gonzalez Della Valle MD, Charles Cornell MD, Thomas Sculco MD, Michael Alexiades MD.
The institution of one of the authors (HMKG) has received funding from the National Institute of Child and Human Development (National Institutes of Health career development grant [R00 HD060686]) and the Agency of Health Research and Quality through a Center for Education and Research on Therapeutics grant (CERTs; Agency of Health Research and Quality RFA-HS-05-14).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at the Hospital for Special Surgery and the Weill Cornell Medical College, New York, NY, USA.