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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2023

Open Access 06-02-2023 | Osteoarthrosis | Knee

Fulfilment of patients’ mandatory expectations are crucial for satisfaction: a study amongst 352 patients after total knee arthroplasty (TKA)

Authors: Cornelia Lützner, Franziska Beyer, Ludwig David, Jörg Lützner

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2023

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Abstract

Purpose

Patient satisfaction with the results of their total knee arthroplasty (TKA) is one of the primary goals of this elective procedure. Furthermore, the association between the fulfilment of patients’ expectations and their satisfaction is well known. The aim of this study was to identify the key expectations of patients awaiting a TKA, evaluate their fulfilment, and compare the outcomes between very and not fully satisfied patients.

Methods

A prospective cohort study of patients with knee OA scheduled for primary TKA was performed. Pre- and one-year postoperatively patient-reported outcome measures (PROMs) were assessed. Expectations and their fulfilment were evaluated via a questionnaire encompassing 31 expectations. Preoperatively, expectations were indicated as mandatory, desirable and not important. Postoperatively, fulfilment was rated as exceeded, fulfilled, partially or not fulfilled, and not applicable. Satisfaction with the results of TKA was measured with a numeric rating scale (NRS) of 0–10. Discrimination between not fully satisfied and very satisfied patients was set at ≥ 8, as has been proposed recently. To identify independent predictors of this discrimination, a multivariate logistic regression analysis was performed.

Results

Complete data sets of 352 patients were analysed. A set of 17 key expectations was identified. Relief of knee pain was fulfilled the most, and improvement of physical function was fulfilled the least. When asked about overall fulfilled expectations, 40% of patients rated them as exceeded, 34% as fulfilled and 26% as less fulfilled than expected. Not fully satisfied patients showed significantly lower PROMs pre- and postoperatively and less fulfilled key expectations. Higher numbers of exceeded and fulfilled mandatory expectations, higher overall fulfilment and better range of motion (ROM) were significant predictors for satisfaction ≥ 8.

Conclusion

Patients’ expectations of TKA outcomes were high with equal emphasis on knee-related and general health-related aspects. Their fulfilment was positively associated with satisfaction. Surgeons should ask patients about mandatory expectations for successful TKA and counsel them about the likelihood of their fulfilment to avoid unrealistic expectations.

Level of evidence

II.
Appendix
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Literature
1.
Amstutz HC, Thomas BJ, Jinnah R, Kim W, Grogan T, Yale C (1984) Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg Am 66:228–241PubMedCrossRef
2.
Barlow T, Clark T, Dunbar M, Metcalfe A, Griffin D (2016) The effect of expectation on satisfaction in total knee replacements: a systematic review. Springerplus 5:167–174PubMedPubMedCentralCrossRef
3.
Barlow T, Griffin D, Barlow D, Realpe A (2015) Patients’ decision making in total knee arthroplasty: a systematic review of qualitative research. Bone Joint Res 4:163–169PubMedPubMedCentralCrossRef
4.
Boateng EY, Abaye DA (2019) A review of the logistic regression model with emphasis on medical research. J Data Anal Inf Process 7:190–207
5.
Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ (2010) Patient satisfaction after total knee arthroplasty who is satisfied and who is not? Clin Orthop 468:57–63PubMedCrossRef
6.
Bryan S, Goldsmith LJ, Davis JC, Hejazi S, MacDonald V, McAllister P et al (2018) Revisiting patient satisfaction following total knee arthroplasty: a longitudinal observational study. BMC Musculoskelet Disord 19:423PubMedPubMedCentralCrossRef
7.
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 16:740–747PubMedCrossRef
8.
Conner-Spady BL, Bohm E, Loucks L, Dunbar MJ, Marshall DA, Noseworthy TW (2020) Patient expectations and satisfaction 6 and 12 months following total hip and knee replacement. Qual Life Res 29:705–719PubMedCrossRef
9.
Cross M, Lapsley H, Barcenilla A, Parker D, Coolican M, March L (2009) Patient expectations of hip and knee joint replacement surgery and postoperative health status. Patient 2:51–60PubMedCrossRef
10.
Dunbar MJ, Richardson G, Robertsson O (2013) I can’t get no satisfaction after my total knee replacement RHYMES AND REASONS. BJJ 95b:148–152
11.
EuroQol G (1990) EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 16:199–208CrossRef
12.
Ghomrawi HMK, Lee LY, Nwachukwu BU, Jain D, Wright T, Padgett D et al (2020) Preoperative expectations associated with postoperative dissatisfaction after total knee arthroplasty: a cohort study. J Am Acad Orthop Surg 28:e145–e150PubMedPubMedCentralCrossRef
13.
Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 32:3854–3860PubMedCrossRef
14.
Hafkamp FJ, Gosens T, de Vries J, den Oudsten BL (2020) Do dissatisfied patients have unrealistic expectations? A systematic review and best-evidence synthesis in knee and hip arthroplasty patients. EFORT Open Rev 5:226–240PubMedPubMedCentralCrossRef
15.
Hamilton DF, Lane JV, Gaston P, Patton JT, Macdonald D, Simpson AH et al (2013) What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement. BMJ Open 3:1–7CrossRef
16.
Hawker GA, Conner-Spady BL, Bohm E, Dunbar MJ, Jones CA, Ravi B et al (2021) Patients’ preoperative expectations of total knee arthroplasty and satisfaction with outcomes at one year: a prospective cohort study. Arthritis Rheum 73:223–231CrossRef
17.
Hepinstall MS, Rutledge JR, Bornstein LJ, Mazumdar M, Westrich GH (2011) Factors that impact expectations before total knee arthroplasty. J Arthroplast 26:870–876CrossRef
18.
Jain D, Nguyen LL, Bendich I, Nguyen LL, Lewis CG, Huddleston JI et al (2017) Higher patient expectations predict higher patient-reported outcomes, but not satisfaction, in total knee arthroplasty patients: a prospective multicenter study. J Arthroplast 32:S166–S170CrossRef
19.
Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE (2018) Patient satisfaction after total knee replacement: a systematic review. HSS J 14:192–201PubMedPubMedCentralCrossRef
20.
Laferton JAC, Oeltjen L, Neubauer K, Ebert DD, Munder T (2022) The effects of patients’ expectations on surgery outcome in total hip and knee arthroplasty: a prognostic factor meta-analysis. Health Psychol Rev 16:50–66PubMedCrossRef
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(2093–2099):e2091
22.
Lützner C, Postler A, Druschke D, Riedel R, Günther K-P, Lange T (2022) Ask patients what they expect! A survey among patients awaiting total hip arthroplasty in Germany. J Arthroplasty 37:1594–1601PubMedCrossRef
23.
Mancuso CA, Graziano S, Briskie LM, Peterson MG, Pellicci PM, Salvati EA et al (2008) Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties. Clin Orthop 466:424–431PubMedPubMedCentralCrossRef
24.
Mancuso CA, Sculco TP, Wickiewicz TL, Jones EC, Robbins L, Warren RF et al (2001) Patients’ expectations of knee surgery. J Bone Joint Surg Am 83:1005–1012PubMedCrossRef
25.
Naal FD, Impellizzeri FM, Sieverding M, Loibl M, von Knoch F, Mannion AF et al (2009) The 12-item oxford knee score: cross-cultural adaptation into German and assessment of its psychometric properties in patients with osteoarthritis of the knee. Osteoarthr Cartil 17:49–52CrossRef
26.
Nakano N, Shoman H, Olavarria F, Matsumoto T, Kuroda R, Khanduja V (2020) Why are patients dissatisfied following a total knee replacement? A systematic review. Int Orthop 44:1971–2007PubMedCrossRef
27.
Nazzal MI, Bashaireh KH, Alomari MA, Nazzal MS, Maayah MF, Mesmar M (2012) Relationship between improvements in physical measures and patient satisfaction in rehabilitation after total knee arthroplasty. IJRR 35:94–101
28.
Noble PC, Conditt MA, Cook KF, Mathis KB (2006) The John Insall award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop 452:35–43PubMedCrossRef
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 Joint Surg Br 94:974–981PubMedCrossRef
30.
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 92:1253–1258PubMedCrossRef
31.
Swarup I, Henn CM, Gulotta LV, Henn RF 3rd (2019) Patient expectations and satisfaction in orthopaedic surgery: a review of the literature. J Clin Orthop Trauma 10:755–760PubMedCrossRef
32.
Tekin B, Unver B, Karatosun V (2012) Expectations in patients with total knee arthroplasty. Acta Orthop Traumatol Turc 46:174–180PubMedCrossRef
33.
Thambiah MD, Nathan S, Seow BZ, Liang S, Lingaraj K (2015) Patient satisfaction after total knee arthroplasty: an Asian perspective. Singapore Med J 56:259–263PubMedPubMedCentralCrossRef
34.
Tilbury C, Haanstra TM, Leichtenberg CS, Verdegaal SH, Ostelo RW, de Vet HC et al (2016) Unfulfilled expectations after total hip and knee arthroplasty surgery: there is a need for better preoperative patient information and education. J Arthroplast 31:2139–2145CrossRef
35.
Tilbury C, Haanstra TM, Verdegaal SHM, Nelissen R, de Vet HCW, Vliet Vlieland TPM et al (2018) Patients’ pre-operative general and specific outcome expectations predict postoperative pain and function after total knee and total hip arthroplasties. Scand J Pain 18:457–466PubMedCrossRef
36.
Tolk JJ, Janssen RPA, Haanstra TM, van der Steen MC, Bierma-Zeinstra SMA, Reijman M (2021) The influence of expectation modification in knee arthroplasty on satisfaction of patients: a randomized controlled trial. BJJ 103-B:619–626
37.
Tolk JJ, Janssen RPA, Haanstra TM, van der Steen MMC, Bierma Zeinstra SMA, Reijman M (2020) Outcome expectations of total knee arthroplasty patients: the influence of demographic factors, pain, personality traits, physical and psychological status. J Knee Surg 33:1034–1040PubMedCrossRef
38.
Uhlmann RF, Inui TS, Carter WB (1984) Patient requests and expectations - definitions and clinical-applications. Med Care 22:681–685PubMedCrossRef
39.
40.
Vissers MM, de Groot IB, Reijman M, Bussmann JB, Stam HJ, Verhaar JA (2010) Functional capacity and actual daily activity do not contribute to patient satisfaction after total knee arthroplasty. BMC Musculoskelet Disord 11:121–129PubMedPubMedCentralCrossRef
41.
42.
Yoo JH, Chang CB, Kang YG, Kim SJ, Seong SC, Kim TK (2011) Patient expectations of total knee replacement and their association with sociodemographic factors and functional status. J Bone Joint Surg Br 93b:337–344CrossRef
Metadata
Title
Fulfilment of patients’ mandatory expectations are crucial for satisfaction: a study amongst 352 patients after total knee arthroplasty (TKA)
Authors
Cornelia Lützner
Franziska Beyer
Ludwig David
Jörg Lützner
Publication date
06-02-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-022-07301-y

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