How Often are Patient and Surgeon Recovery Expectations for Total Joint Arthroplasty Aligned? Results of a Pilot Study

Abstract

Background

Surgeons strive to set patient expectations for recovery following total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, some patients report dissatisfaction after surgery due to unmet expectations.

Purpose

We compared patients’ and surgeon’s recovery expectations prior to primary THA and TKA.

Methods

Sixty eight patients scheduled to undergo primary total hip replacement (THR) or total knee replacement (TKR) surgery were enrolled. Before surgery, patients filled out a validated recovery expectations questionnaire that quantified expectations of postoperative pain relief, function, and well-being with a value from 0 to 100 (higher being more optimistic). The surgeon independently completed the same questionnaire for each patient. Overall score and item-specific comparisons were conducted. Correlations were explored between agreement level, demographics, patient-reported health status measures, and patients’ assessments of the risk of complications associated with surgery.

Results

Most patients undergoing THR or TKR had higher expectations for recovery than their surgeon. Applying the clinically meaningful difference in expectations (≥7 points), 52.5% of the TKA patients’ expectations exceeded those of the surgeon, while 22.5% expected less than their surgeon and 60.7% of THA patients’ expectations exceeded those of the surgeon, while 21.4% expected less than their surgeon. THA patients with either lower or higher expectations than their surgeon had lower physical and mental health status scores. TKA patients with lower expectations compared to their surgeon had a higher expectation of complications.

Conclusions

More than 50% of the patients had higher expectations than their surgeon and this was driven by expectations of high-level activities and extreme range of motion. Further investigations are needed to understand these differences so as to enhance patient preoperative education.

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Correspondence to Alejandro Gonzalez Della Valle MD.

Additional information

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. This research was supported by the generous donation of Mr. Salomon Melkman and by the Center for Education and Research on Therapeutics (CERTs; Agency of Health Research and Quality RFA-HS-05-14). Dr. Ghomrawi is supported in part by a career development grant from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (K99 HD060686). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with the ethical principles of research, and that informed consent for participating in the study was obtained.

Level of evidence: level 1, prognostic study

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Ghomrawi, H.M.K., Franco Ferrando, N., Mandl, L.A. et al. How Often are Patient and Surgeon Recovery Expectations for Total Joint Arthroplasty Aligned? Results of a Pilot Study. HSS Jrnl 7, 229–234 (2011). https://doi.org/10.1007/s11420-011-9203-6

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Keywords

  • total hip replacement
  • total knee replacement
  • preoperative expectations
  • discordance