Associations between patient expectations of joint arthroplasty surgery and pre- and post-operative clinical status

Abstract

Improvements in implant materials and designs have broadened surgical indications and improved the technical successes of joint arthroplasty surgery. Nevertheless, a small but notable proportion of patients remain dissatisfied despite technically successful surgery. Given reported associations between unfulfilled patient expectations and dissatisfaction, we performed a systematic review to investigate the current state of knowledge concerning potential associations between clinical status and patient expectations of joint arthroplasty procedures. A wide range of expectation assessment instruments was identified, some of which assessed probabilistic expectations and other value-based expectations. Consistent associations were identified between probabilistic expectations of surgery and better pre-operative disease-specific and general health status, as well as more desirable post-operative disease specific scores. In contrast, no consistent associations were identified between clinical status and value-based expectations. Fulfillment of expectations was consistently associated with superior disease-specific and general health absolute and change scores, irrespective of the expectations paradigm used.

Keywords::

• joint replacement
• orthopaedic surgery
• patient reported outcomes
• reimbursement
• satisfaction

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• A small but notable proportion of patients who undergo joint arthroplasty remains dissatisfied with the results of treatment, despite technically successful surgery.

• Associations have been reported between satisfaction and fulfillment of expectations of surgery.

• Patient expectations can be stratified into those results considered to be most likely to occur (i.e., probabilistic), and those patients would be most likely to experience (i.e., value based).

• Consistent associations have been reported between greater probabilistic expectations of arthroplasty surgery and both better baseline clinical status and superior postoperative clinical outcome.

• No consistent associations have been reported between value-based expectations and either preoperative or postoperative clinical status.

• Fulfillment of expectations, regardless of paradigm, is associated with better absolute clinical outcomes and greater improvement in clinical scores following arthroplasty surgery.

• An increasing emphasis on the fulfillment of patient expectations of arthroplasty surgery may positively affect patient-reported outcomes and satisfaction, measures that are being increasingly required by both health care payors and regulatory agencies.

• Considerable work remains to be done to fully understand the complex, multifactorial and dynamic relationships between patient expectations of arthroplasty surgery, baseline clinical status, clinical outcomes and satisfaction.

Notes

AAOS: American Academy of Orthopedic Surgeons; HHS: Harris Hip Score; KOOS: Knee Injury and Osteoarthritis Outcome Scale; SF-12: Short form 12; SF-36: Short form 36THA: Total hip arthroplasty; VAS: Visual analogue scale; WOMAC: Western Ontario and McMaster Universities’ Osteoarthritis Index.