Skip to main content
SpringerLink
Log in

The discrepancy between patient expectations and actual outcome reduces at the first 6 months following total knee replacement surgery

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Patients undergoing total knee arthroplasty often have unfulfilled expectations from the surgery that can lead to dissatisfaction. This study aimed to examine the discrepancy between patients’ expectations and actual functional abilities prior to undergoing knee replacement surgery, and at 6 and 12 months following the surgery.

Methods

A survey was undertaken of patients before, and 6 and 12 months post-surgery. The survey included the Knee Surgery Perception Questionnaire (KSPQ) to assess patients’ current perception of their level of function and pain, their desired outcomes, and the discrepancy between the two. Pain, function and quality of life were also assessed. Repeated measure ANOVAs were used to assess differences between pre- and post-surgery.

Results

A total of 176 patients were surveyed. Significant differences in the KSPQ discrepancy scores (subscale and total scores) were demonstrated between the three assessment point times (p < 0.01). Paired t tests identified significant differences between the pre-surgery and 6-month KSPQ discrepancy scores, (p < 0.01) indicative of substantial improvement in physical function and slight reduction in expectations. Overall significant improvement (p < 0.01) was reported over time across all measures: physical function, pain and stiffness and quality of life.

Conclusion

The discrepancy between patients’ current abilities and their expectation changes following surgery, especially in the first 6 months post-surgery. Patients’ goals might change as their function and pain improve post-surgery. Combining education programmes and discussion with the treating orthopaedic surgeons pre-operatively is important for the development of realistic, achievable expectations.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ayers DC, Franklin PD, Trief PM, Ploutz-Snyder R, Freund D (2004) Psychological attributes of preoperative total joint replacement patients: implications for optimal physical outcome. J Arthroplasty 19(7 Suppl 2):125–130

    Article  PubMed  Google Scholar 

  2. Baker PN, van der Meulen JH, Lewsey J, Gregg PJ (2007) The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Jt Surg Br 89(7):893–900

    Article  CAS  Google Scholar 

  3. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  4. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63

    Article  PubMed  Google Scholar 

  5. Brander V, Gondek S, Martin E, Stulberg SD (2007) Pain and depression influence outcome 5 years after knee replacement surgery. Clin Orthop Relat Res 464:21–26

    PubMed  Google Scholar 

  6. Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, Houle T (2003) Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res 416:27–36

    Article  Google Scholar 

  7. Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, Westlake L (1992) Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 305(6846):160–164

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Bullens PH, van Loon CJ, de Waal Malefijt MC, Laan RF, Veth RP (2001) Patient satisfaction after total knee arthroplasty: a comparison between subjective and objective outcome assessments. J Arthroplasty 16(6):740–747

    Article  CAS  PubMed  Google Scholar 

  9. Clode NJ, Perry MA, Wulff L (2018) Does physiotherapy prehabilitation improve pre-surgical outcomes and influence patient expectations prior to knee and hip joint arthroplasty? Int J Orthop Trauma Nurs 30:14–19

    Article  PubMed  Google Scholar 

  10. Edwards P, Roberts I, Clarke M, DiGuiseppi C, Pratap S, Wentz R, Kwan I, Cooper R (2007) Methods to increase response rates to postal questionnaires. Cochrane Database Syst Rev (2): MR000008

  11. Gandhi R, Dhotar H, Razak F, Tso P, Davey JR, Mahomed NN (2010) Predicting the longer term outcomes of total knee arthroplasty. Knee 17(1):15–18

    Article  PubMed  Google Scholar 

  12. Ghomrawi HM, Mancuso CA, Westrich GH, Marx RG, Mushlin AI (2013) Discordance in TKA expectations between patients and surgeons. Clin Orthop Relat Res 471(1):175–180

    Article  PubMed  Google Scholar 

  13. Hepinstall MS, Rutledge JR, Bornstein LJ, Mazumdar M, Westrich GH (2011) Factors that impact expectations before total knee arthroplasty. J Arthroplasty 26(6):870–876

    Article  PubMed  Google Scholar 

  14. Hirschmann MT, Testa E, Amsler F, Friederich NF (2013) The unhappy total knee arthroplasty (TKA) patient: higher WOMAC and lower KSS in depressed patients prior and after TKA. Knee Surg Sports Traumatol Arthrosc 21(10):2405–2411

    Article  PubMed  Google Scholar 

  15. Jain D, Nguyen LL, Bendich I, Nguyen LL, Lewis CG, Huddleston JI, Duwelius PJ, Feeley BT, Bozic KJ (2017) Higher patient expectations predict higher patient-reported outcomes, but not satisfaction, in total knee arthroplasty patients: a prospective multicenter study. J Arthroplasty 32(9S):S166–S170

    Article  PubMed  Google Scholar 

  16. Jones AC, Suarez-Almazor ME (2017) Patients expectations and total knee arthroplasty. J Clin Outcomes Manag 24(8):364–370

    Google Scholar 

  17. Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE (2018) Patient satisfaction after total knee replacement: a systematic review. Hss J 14(2):192–201

    Article  PubMed  PubMed Central  Google Scholar 

  18. Khatib Y, Madan A, Naylor JM, Harris IA (2015) Do Psychological factors predict poor outcome in patients undergoing TKA? A systematic review. Clin Orthop Relat Res 473(8):2630–2638

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kim TK, Chang CB, Kang YG, Kim SJ, Seong SC (2009) Causes and predictors of patient’s dissatisfaction after uncomplicated total knee arthroplasty. J Arthroplasty 24(2):263–271

    Article  PubMed  Google Scholar 

  20. Kim TK, Kwon SK, Kang YG, Chang CB, Seong SC (2010) Functional disabilities and satisfaction after total knee arthroplasty in female Asian patients. J Arthroplasty 25(3):458–464

    Article  PubMed  Google Scholar 

  21. Lange T, Schmitt J, Kopkow C, Rataj E, Gunther KP, Lutzner J (2017) What Do Patients Expect From Total Knee Arthroplasty? A Delphi Consensus Study on Patient Treatment Goals. J Arthroplasty 32(7):2093–2099 e2091

    Article  PubMed  Google Scholar 

  22. Levinger P, Diamond NT, Menz HB, Wee E, Margelis S, Stewart AG, Bartlett JR, Bergman NB, McMahon S, Hare DL, Hill K (2016) Development and validation of a questionnaire assessing discrepancy between patients’ pre-surgery expectations and abilities and post-surgical outcomes following knee replacement surgery. Knee Surg Sports Traumatol Arthrosc 24(10):3359–3368

    Article  PubMed  Google Scholar 

  23. Loft M, McWilliam C, Ward-Griffin C (2003) Patient empowerment after total hip and knee replacement. Orthop Nurs 22(1):42–47

    Article  PubMed  Google Scholar 

  24. Mancuso CA, Graziano S, Briskie LM, Peterson MG, Pellicci PM, Salvati EA, Sculco TP (2008) Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties. Clin Orthop Relat Res 466(2):424–431

    Article  PubMed  PubMed Central  Google Scholar 

  25. McHorney CA, Ware JE Jr, Raczek AE (1993) The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical care 31(3):247–263

    Article  CAS  PubMed  Google Scholar 

  26. Neuprez A, Delcour JP, Fatemi F, Gillet P, Crielaard JM, Bruyere O, Reginster JY (2016) Patients’ expectations impact their satisfaction following total hip or knee arthroplasty. PLoS One 11(12):e0167911

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Noble PC, Conditt MA, Cook KF, Mathis KB (2006) The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43

    Article  PubMed  Google Scholar 

  28. Scott CE, Howie CR, MacDonald D, Biant LC (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 92(9):1253–1258

    Article  CAS  PubMed  Google Scholar 

  29. Scott CE, Bugler KE, Clement ND, MacDonald D, Howie CR, Biant LC (2012) Patient expectations of arthroplasty of the hip and knee. J Bone Jt Surg Br 94(7):974–981

    Article  CAS  Google Scholar 

  30. Sethuraman V, McGuigan J, Hozack WJ, Sharkey PF, Rothman RH (2000) Routine follow-up office visits after total joint replacement: do asymptomatic patients wish to comply? J Arthroplasty 15(2):183–186

    Article  CAS  PubMed  Google Scholar 

  31. SF-36 physical and Mental Health Summary Scales: A Manual for Users of Version 1 (1997) The Health Institute, New England Medical Center, Boston

Download references

Acknowledgements

The authors would like to thank Elin Wee and Soula Margelis for their assistance with patient recruitment and data collection.

Funding

No external funding was used.

Author information

Authors and Affiliations

  1. National Ageing Research Institute Ltd, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia

    Pazit Levinger

  2. School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, 3086, Australia

    Pazit Levinger & Hylton B. Menz

  3. Warringal Private Medical Centre, Heidelberg, VIC, 3084, Australia

    John R. Bartlett & Neil R. Bergman

  4. The Avenue Hospital, 3181, Windsor, VIC, Australia

    Stephen McMahon

  5. School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, 6845, Australia

    Keith D. Hill

Authors
  1. Pazit Levinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John R. Bartlett
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Neil R. Bergman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephen McMahon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hylton B. Menz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keith D. Hill
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pazit Levinger.

Ethics declarations

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

Ethical approval was received from the La Trobe University Human Research Ethics Committee (FHEC09/230).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 425 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Levinger, P., Bartlett, J.R., Bergman, N.R. et al. The discrepancy between patient expectations and actual outcome reduces at the first 6 months following total knee replacement surgery. Knee Surg Sports Traumatol Arthrosc 27, 2042–2050 (2019). https://doi.org/10.1007/s00167-018-5210-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-018-5210-1

Keywords

Search

Navigation