Expectation, satisfaction and clinical outcome of patients after total knee arthroplasty

  • Roland BeckerEmail author
  • Carl Döring
  • Andreas Denecke
  • Mathias Brosz



There is a well-known difference between patients expectation, satisfaction and the measured clinical outcome in total knee arthroplasty (TKA). It has been hypothesized that higher expectation prior to surgery and higher satisfaction will show better clinical outcome according to well-established scoring systems, frequently used for assessment after TKA.


A consecutive group of 102 patients was included who received TKA for degenerative osteoarthritis. A modified patients expectation form was used prior and 8 months after surgery. Furthermore, the KSS, WOMAC and SF-36 served for patient assessment. Patients were grouped in responder and non-responder according to their level of expectation and fulfilment of expectation after surgery using a Likert scale.


A total of 54 patients (53%) showed expectation prior to surgery of 1 or 2 and a satisfaction after surgery of 1 or 2 according to the Likert scales. These patients were classified as responders. Considering the continuous parameters of KSS, SF-36 and WOMAC, a few statistically significant differences were found between the responders and non-responders at baseline (pre-surgery) and at the fulfilment of their expectation after surgery. Patient expectation prior to surgery did not differ between both groups. The more satisfied patients showed significant better results in the KSS, WOMAC and SF-36 after surgery. The parameters general health (SF-36) and role emotional (SF-36) measured prior to surgery dominate the predictive potential to get a responder with sensitivity of 74%, specificity of 81% and a rate of correct classification of 78%.


This study has shown that patient satisfaction correlates well with the clinical outcome according to the KSS, WOMAC and SF-36. The indication for TKA should consider the general health, emotional role and knee function of the patients as well in order to predict patient’s outcome.

Level of evidence



Patient’s expectation Satisfaction Total knee arthroplasty Clinical outcome 


  1. 1.
    Alzahrani K, Gandhi R, Debeer J, Petruccelli D, Mahomed N (2011) Prevalence of clinically significant improvement following total knee replacement. J Rheumatol 38:753–759PubMedCrossRefGoogle Scholar
  2. 2.
    Baumann C, Rat AC, Osnowycz G, Mainard D, Cuny C, Guillemin F (2009) Satisfaction with care after total hip or knee replacement predicts self-perceived health status after surgery. BMC Musculoskelet Disord 10:150PubMedCrossRefGoogle Scholar
  3. 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 15:1833–1840PubMedGoogle Scholar
  4. 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 468:57–63PubMedCrossRefGoogle Scholar
  5. 5.
    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 416:27–36PubMedCrossRefGoogle Scholar
  6. 6.
    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 16:740–747PubMedCrossRefGoogle Scholar
  7. 7.
    Bullinger M (1995) German translation and psychometric testing of the SF-36 health survey: preliminary results from the IQOLA project. International quality of life assessment. Soc Sci Med 41:1359–1366PubMedCrossRefGoogle Scholar
  8. 8.
    Dorr LD, Chao L (2007) The emotional state of the patient after total hip and knee arthroplasty. Clin Orthop Relat Res 463:7–12PubMedGoogle Scholar
  9. 9.
    Engel C, Hamilton NA, Potter PT, Zautra AJ (2004) Impact of two types of expectancy on recovery from total knee replacement surgery (TKR) in adults with osteoarthritis. Behav Med 30:113–123PubMedCrossRefGoogle Scholar
  10. 10.
    Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY (2004) Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 86:963–974PubMedGoogle Scholar
  11. 11.
    Forsythe ME, Dunbar MJ, Hennigar AW, Sullivan MJ, Gross M (2008) Prospective relation between catastrophizing and residual pain following knee arthroplasty: two-year follow-up. Pain Res Manag 13:335–341PubMedGoogle Scholar
  12. 12.
    Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, Phillips C, Partridge AJ, Bélisle P, Fossel AH, Mahomed N, Sledge CB, Katz JN (1999) Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum 42:1722–1728PubMedCrossRefGoogle Scholar
  13. 13.
    Fortin PR, Penrod JR, Clarke AE, St-Pierre Y, Joseph L, Bélisle P, Liang MH, Ferland D, Phillips CB, Mahomed N, Tanzer M, Sledge C, Fossel AH, Katz JN (2002) Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum 46:3327–3330PubMedCrossRefGoogle Scholar
  14. 14.
    Fuchs S, Skwara A, Rosenbaum D (2005) Preliminary results after total knee arthroplasty without femoral trochlea: evaluation of clinical results, quality of life and gait function. Knee Surg Sports Traumatol Arthrosc 13:664–669PubMedCrossRefGoogle Scholar
  15. 15.
    Gandhi R, Tsvetkov D, Davey JR, Syed KA, Mahomed NN (2009) Relationship between self-reported and performance-based tests in a hip and knee joint replacement population. Clin Rheumatol 28:253–257PubMedCrossRefGoogle Scholar
  16. 16.
    Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, Katz B, Bombardier C, Heck D, Freund D (1998) Health-related quality of life after knee replacement. J Bone Joint Surg Am 80:163–173PubMedGoogle Scholar
  17. 17.
    Hirvonen J, Blom M, Tuominen U, Seitsalo S, Lehto M, Paavolainen P, Hietaniemi K, Rissanen P, Sintonen H (2007) Evaluating waiting time effect on health outcomes at admission: a prospective randomized study on patients with osteoarthritis of the knee joint. J Eval Clin Pract 13:728–733PubMedCrossRefGoogle Scholar
  18. 18.
    Husted H, Holm G, Jacobsen S (2008) Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 79:168–173PubMedCrossRefGoogle Scholar
  19. 19.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14PubMedGoogle Scholar
  20. 20.
    Kim TK, Chang CB, Kang YG, Kim SJ, Seong SC (2009) Causes and predictors of patient’s dissatisfaction after uncomplicated total knee arthroplasty. J Arthroplast 24:263–271CrossRefGoogle Scholar
  21. 21.
    Kirwan JR, Currey HL, Freeman MA, Snow S, Young PJ (1994) Overall long-term impact of total hip and knee joint replacement surgery on patients with osteoarthritis and rheumatoid arthritis. Br J Rheumatol 33:357–360PubMedCrossRefGoogle Scholar
  22. 22.
    Kowalchuk DA, Harner CD, Fu FH, Irrgang JJ (2009) Prediction of patient-reported outcome after single-bundle anterior cruciate ligament reconstruction. Arthroscopy 25:457–463PubMedCrossRefGoogle Scholar
  23. 23.
    Kramer JF, Speechley M, Bourne R, Rorabeck C, Vaz M (2003) Comparison of clinic- and home-based rehabilitation programs after total knee arthroplasty. Clin Orthop Relat Res 410:225–234PubMedCrossRefGoogle Scholar
  24. 24.
    Lieberman JR, Dorey F, Shekelle P, Schumacher L, Thomas BJ, Kilgus DJ, Finerman GA (1996) Differences between patients’ and physicians’ evaluations of outcome after total hip arthroplasty. J Bone Joint Surg Am 78:835–838PubMedGoogle Scholar
  25. 25.
    Lingard EA, Katz JN, Wright EA, Sledge CB, Group Kinemax Outcomes (2004) Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am 86:2179–2186PubMedGoogle Scholar
  26. 26.
    Lingard EA, Riddle DL (2007) Impact of psychological distress on pain and function following knee arthroplasty. J Bone Joint Surg Am 89:1161–1169PubMedCrossRefGoogle Scholar
  27. 27.
    Mahomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Fossel AH, Katz JN (2002) The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol 29:1273–1279PubMedGoogle Scholar
  28. 28.
    Mannion AF, Kämpfen S, Munzinger U, Kramers-de Quervain I (2009) The role of patient expectations in predicting outcome after total knee arthroplasty. Arthritis Res Ther 11:R139PubMedCrossRefGoogle Scholar
  29. 29.
    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 452:35–43PubMedCrossRefGoogle Scholar
  30. 30.
    Stucki G, Stucki S, Sangha O (1997) Patient-centered evaluation of illness outcome in musculoskeletal diseases: adaptation and revision of outcome instruments. Z Rheumatol 56:266–275PubMedCrossRefGoogle Scholar
  31. 31.
    Ware JE, Gandek B (1998) Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. J Clin Epidemiol 51:903–912PubMedCrossRefGoogle Scholar
  32. 32.
    Ware JE, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A (1995) Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the medical outcomes study. Med Care 33:264–279CrossRefGoogle Scholar
  33. 33.
    Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483PubMedCrossRefGoogle Scholar
  34. 34.
    Williams JI, Llewellyn Thomas H, Arshinoff R, Young N, Naylor CD (1997) The burden of waiting for hip and knee replacements in Ontario. Ontario hip and knee replacement project team. J Eval Clin Pract 3:59–68PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Roland Becker
    • 1
    • 4
    Email author
  • Carl Döring
    • 2
  • Andreas Denecke
    • 1
  • Mathias Brosz
    • 3
  1. 1.Department of Orthopaedic and TraumatologyCity-Hospital BrandenburgBrandenburgGermany
  2. 2.Department of Traumatology and Hand SurgeryHospital WaldfriedeBerlinGermany
  3. 3.StatConsult GmbHMagdeburgGermany
  4. 4.Deptartment of OrthopaedicsOtto-von-Guericke-UniversityMagdeburgGermany

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