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

Hassan M. Ghomrawi, PhD, MPH
Division of Health Policy Department of Public Health, Weill Cornell Medical College
Epidemiology and Biostatistics Core, Hospital for Special Surgery

Nuria Franco Ferrando, MD
Department of Orthopaedics, Hospital Universitario La Fr, Valencia, Spain


Lisa A. Mandl, MD

Assistant Attending Physician, Hospital for Special Surgery
Assistant Professor of Medicine, Weill Cornell Medical College
Assistant Professor of Public Health, Weill Cornell Medical College

Huong Do, MS
Epidemiology and Biostatistics Core, Hospital for Special Surgery

Neaz Noor, BS
Division of Health Policy Department of Public Health, Weill Cornell Medical College

Alejandro Gonzalez Della Valle, MD
Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College

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 patientsí and surgeonís 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 patientsí 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 patientsí expectations exceeded those of the surgeon, while 22.5% expected less than their surgeon and 60.7% of THA patientsí 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.

This article appears in HSS Journal: Volume 7, Number 3.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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