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Preoperative education on realistic expectations improves the satisfaction of patients with central sensitization after total knee arthroplasty: a randomized-controlled trial

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to investigate whether an additional module on realistic expectations following total knee arthroplasty (TKA) would lead to a higher proportion of satisfied patients compared to existing preoperative education.

Methods

This was a single-center, randomized-controlled trial. A total of 172 patients who were scheduled for TKA between September 2020 and October 2021 were enrolled. Patients were randomized to receive either only standard preoperative education, or an additional module on realistic expectations following TKA. The primary outcome was patient satisfaction. Secondary outcomes were Short Form-36, Western Ontario and McMaster Universities Osteoarthritis Index, crepitus score, and range of motion. Subgroup analysis was performed based on central sensitization inventory (CSI) score stratification. Assessment was performed at the 3-month, 6-month, and > 1-year follow-up.

Results

At more than 1 year, 65/78 (83.3%) patients in the intervention group and 52/80 (65.0%) patients in the control group were satisfied (P = 0.03). The mean satisfaction score was measured as 4.2 ± 0.9 in the intervention and 3.9 ± 0.9 in the control at > 1 year (P = 0.01). There were significant differences in Short Form-36 physical and mental component summary scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness scores at 6 months (P = 0.02, P = 0.02, P = 0.04, P = 0.04). The frequency of satisfaction and mean satisfaction score in the top 25 percentile CSI group were 15/16 (93.8%) and 4.6 ± 0.6 in those who received intervention and 12/19 (63.2%) and 3.8 ± 0.8 in those who did not (P = 0.01, P = 0.01).

Conclusions

Thorough preoperative education on realistic expectations following TKA showed effects on WOMAC pain and satisfaction at > 1 year after surgery. It was more prominent in the group with a higher CSI score at > 1-year follow-up.

Level of evidence

Level I.

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Data Availability

The data that support the findings of this study are available upon reasonable request.

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Funding

This study received no financial support.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea

    Hee Seung Nam, Hyun Jin Yoo, Jade Pei Yuik Ho & Yong Seuk Lee

  2. Department of Orthopedic Surgery, Konyang University College of Medicine, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, South Korea

    Hyun Jin Yoo

  3. Department of Orthopedic Surgery, Soonchunhyang University College of Medicine,, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, South Korea

    Yong Beom Kim

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Correspondence to Yong Seuk Lee.

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The authors declare no conflict of interest.

Ethical Approval Statement

The study protocol was approved by the Seoul National University Bundang Hospital Institutional Review Board (Approval number: B-2007/622-304). All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Nam, H.S., Yoo, H.J., Ho, J.P.Y. et al. Preoperative education on realistic expectations improves the satisfaction of patients with central sensitization after total knee arthroplasty: a randomized-controlled trial. Knee Surg Sports Traumatol Arthrosc 31, 4705–4715 (2023). https://doi.org/10.1007/s00167-023-07487-9

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  • DOI: https://doi.org/10.1007/s00167-023-07487-9

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