Understanding Patient Expectations Before Total Knee Arthroplasty: Influencing Factors and Outcomes
This study investigates how patient attributes such as age, gender, and health status affect expectations prior to total knee arthroplasty (TKA). Analyzing data from 1943 patients over a year, results reveal that younger, male, and healthier individuals harbor significantly higher expectations. Key factors influencing these expectations include living arrangements and previous health history, but education level shows no correlation. Understanding and managing these expectations could enhance patient satisfaction and outcomes. It emphasizes the necessity for clear communication about realistic surgical results.
Understanding Patient Expectations Before Total Knee Arthroplasty: Influencing Factors and Outcomes
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Presentation Transcript
Introduction • Higherexpectations, betteroutcomes • Unrealisticexpectations, dissatisfaction • Information can influenceexpectations
Objective Examine theeffect of patientattributesonexpectationsbefore TKA
Materials and Methods • Prospectivestudy • Exclusioncriteria • Refusalorinabilityto complete study • 1943 patients (1st may 2008/30th april 2009) • Variables • Kneeexpectationssurvey, VAS, SF-36, KOOS, LEAS • Demographicparameters • Questionnaires 2 weeksbeforesurgery
Statistics • SAS software package • Pearsoncorrelationcoefficients (r) • r>0,6 strongcorrelation • 0,3<r<0,6 moderatecorrelation • 0,1<r<0,3 weakcorrelation
Results • 3035 patientsoperated in thatperiod • 1943 studypopulation • Mean age 67 +/-10 years • 51% over 80 in KES (Highexpectations) • Younger, male and whitepatientshadsignificantlyhigherexpectations (p<0.05) • No relationshipwithlevel of education
Results • Living with a partner, higherexpectations • Higherexpectations of returntosexual function? • Thedifferenceremainedwhenquestionwas removed • Healthierpatients, higherexpectations • Higherquality of life, higherexpectations • More active patients, higherexpectations • History of TJA, lowerexpectations
Discussion • Patientsatisfactionmaybedependentonmanagingexpectations • Patientswithlowexpectations, lesslikelytoelectsurgery • Statisticallysignificanteffect of race, whenmultivariateanalysisthediferencedisappeared (confounding factor) • Live alone, lowerexpectations, no familysupport
Discussion • No influence of pre-opkneepainorfunction • No modulation of theirexpectationsbasedon pre-op status of theknee • Patientshigherexpectationsthantheirsurgeons • Experience leads to more accurateexpectations • Identifying and addressingunrealisticexpectations, more satisfaction
Discussion • Correlationsobservedweresmall • Theydon’texplaintheobservedvariability • Otherfactors (influencingtheexpectations): • Largesamplesize (eliminatesignificant variables of smallstudies) • Psychologicalprofile • Lifeexpiriencewithsurgery • Perceptionbyfriendsorfamily
Conclusion • Highpotentiallyunrealisticexpectations are common and notconfinedtoyoungor active patients, highlightingtheneedfordiscussion of realisticexpectationswithallpatients
Limitations • Using a validated mesure, but • Subjectiveexpectationsurvey (frame-of-reference) • 50 yearsoldpatientwhoclimbed Everest • 75 yearsoldpatientwhoexpects a full returntobowling • Future mesures shouldbe more especific • Specific center withspecificpopulation
