Abstract
Patients have multiple expectations of THA and TKA. We asked whether preoperative educational classes addressing recovery during the first year could modify patients’ expectations of their 12-month postoperative recovery. Participants were enrolled consecutively in two randomized, controlled trials, one for THA (177 patients) and one for TKA (143 patients). Control patients preoperatively received a standard THA or TKA class addressing recovery immediately after surgery. Intervention patients preoperatively received the standard class plus a joint-specific module addressing recovery during the first 12 months. Before and after the class, patients completed either a hip-specific or knee-specific validated expectations survey. The main outcome was the within-patient change in expectation scores (maximum increase, +100; maximum decrease, −100) before and after the class but preoperatively. Mean changes in hip scores were +3.3 ± 8 for intervention patients (range, −22–+32) and +4.9 ± 8 for control patients (range, −13–+29). Mean changes in knee scores were −3.4 ± 10 for intervention patients (range, −26–+33) and +2.4 ± 10 for control patients (range, −30–+30). Patients’ preoperative expectations of their recovery from THA or TKA can be modified by preoperative educational classes.
Level of Evidence: Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Similar content being viewed by others
References
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes following total hip or knee arthroplasty in osteoarthritis. J Orthop Rheumatol. 1988;1:95–108.
Bellamy N, Campbell J, Hill J, Band P. A comparative study of telephone versus onsite completion of the WOMAC 3.0 osteoarthritis index. J Rheumatol. 2002;29:783–786.
Chang HJ, Mehta PS, Rosenberg A, Scrimshaw SC. Concerns of patients actively contemplating total knee replacement: differences by race and gender. Arthritis Rheum. 2004;51:117–123.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40:373–383.
Eisler T, Svensson O, Tengström A, Elmstedt E. Patient expectation of satisfaction in revision total hip arthroplasty. J Arthroplasty. 2002;17:457–462.
Flood AB, Lorence DP, Ding J, McPherson K, Black NA. The role of expectations in patients’ reports of post-operative outcomes and improvement following therapy. Med Care. 1993;31:1043–1056.
Furstenberg AL. Expectations about outcome following hip fracture among older people. Soc Work Health Care. 1986;11:33–47.
Haddad FS, Garbuz DS, Chambers GK, Jagpal TJ, Masri BA, Duncan CP. The expectations of patients undergoing revision hip arthroplasty. J Arthroplasty. 2001;16:87–91.
Hawker GA. Who, when and why total joint replacement surgery? The patient’s perspective. Curr Opin Rheumatol. 2006;18:526–530.
Iversen MD, Daltroy LH, Fossel AH, Katz JN. The prognostic importance of patient pre-operative expectations of surgery for lumbar spinal stenosis. Patient Educ Couns. 1998;34:169–178.
Lieberman JR, Thomas BJ, Finerman GA, Dorey F. Patients’ reasons for undergoing total hip arthroplasty can change over time. J Arthroplasty. 2003;18:63–68.
Lingard EA, Sledge CB, Learmonth ID. Kinemax Outcomes Group. Patient expectations regarding total knee arthroplasty: differences among the United States, United Kingdom, and Australia. J Bone Joint Surg Am. 2006;88:1201–1207.
Lutz GK, Butzlaff ME, Atlas SJ, Keller RB, Singer DE, Deyo RA. The relation between expectations and outcome in surgery for sciatica. J Gen Intern Med. 1999;14:740–744.
Mahomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Fossel AH, Katz JN. The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol. 2002;29:1273–1279.
Mancuso CA, Altchek DW, Craig EV, Jones EC, Robbins L, Warren RF, Williams-Russo P. Patients’ expectations of shoulder surgery. J Shoulder Elbow Surg. 2002;11:541–549.
Mancuso CA, Charlson ME. Does recollection error threaten the validity of cross-sectional studies of effectiveness? Med Care. 1995;33(4 suppl):AS77–AS88.
Mancuso CA, Salvati EA, Johanson NA, Peterson MG, Charlson ME. Patients’ expectations and satisfaction with total hip arthroplasty. J Arthroplasty. 1997;12:387–396.
Mancuso CA, Sculco TP, Salvati EA. Patients with poor preoperative functional status have high expectations of total hip arthroplasty. J Arthroplasty. 2003;18:872–878.
Mancuso CA, Sculco TP, Wickiewicz TL, Jones EC, Robbins L, Warren RF, Williams-Russo P. Patients’ expectations of knee surgery. J Bone Joint Surg Am. 2001;83:1005–1012.
Marcinkowski K, Wong VG, Dignam D. Getting back to the future: a grounded theory study of the patient perspective of total knee joint arthroplasty. Orthop Nurs. 2005;24:202–209.
McGregor AH, Rylands H, Owen A, Doré CJ, Hughes SP. Does preoperative hip rehabilitation advice improve recovery and patient satisfaction? J Arthroplasty. 2004;19:464–468.
McHorney CA, Kosinski M, Ware JE Jr. Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: results from a national survey. Med Care. 1994;32:551–567.
Mondloch MV, Cole DC, Frank JW. Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes. [Erratum in CMAJ. 2001;165:1303.] CMAJ. 2001;165:174–179.
Moran M, Khan A, Sochart DH, Andrew G. Expect the best, prepare for the worst: surgeon and patient expectation of the outcome of primary total hip and knee replacement. Ann R Coll Surg Engl. 2003;85:204–206.
Noble PC, Conditt MA, Cook KF, Mathis KB. Patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006;452:35–43.
SAS User’s Guide: Statistics. 5th ed. Cary, NC: SAS Institute Inc; 1985.
Stewart AL, Hays RD, Ware JE Jr. The MOS Short-Form General Health Survey: reliability and validity in a patient population. Med Care. 1988;26:724–732.
Uhlmann RF, Inui TS, Carter WB. Patient requests and expectations: definitions and clinical applications. Med Care. 1984;22:681–685.
Venkataramanan V, Gignac MA, Mahomed NN, Davis AM. Expectations of recovery from revision knee replacement. Arthrit Care Res. 2006;55:314–321.
Acknowledgments
We thank Steven B. Haas, MD, Russell E. Windsor, MD, Lobel Lurie, RN, and Jeanmarie Ginty-Zusi, RN, for their participation.
Author information
Authors and Affiliations
Corresponding author
Additional information
One or more of the authors (CAM) have received funding from the Department of Orthopedic Surgery, Hospital for Special Surgery, and the Center for Aging Research and Clinical Care, Division of Geriatrics and Gerontology, Joan and Sanford I. Weill Medical College of Cornell University through NIA AG00853.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.
The Corresponding Author confirms all seven authors were required to design this trial.
About this article
Cite this article
Mancuso, C.A., Graziano, S., Briskie, L.M. et al. Randomized Trials to Modify Patients’ Preoperative Expectations of Hip and Knee Arthroplasties. Clin Orthop Relat Res 466, 424–431 (2008). https://doi.org/10.1007/s11999-007-0052-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-007-0052-z