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What determines patient expectations of total knee arthroplasty?
ESSKA Academy. Tolk J. May 11, 2018; 218087; FP37-1244
Mr. J.J. Tolk
Mr. J.J. Tolk
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Abstract
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Objectives: Unrealistic preoperative expectations have strong influence on the outcome after total knee arthroplasty (TKA). Little is known about the effect of psychological factors on these expectations. More insight in determinants of the height of expectations can be useful in guiding pre-operative expectation management. The current study analyses the effect of pre-operative factors on outcome expectations in TKA. We hypothesized that psychological factors such as depressive symptoms, coping mechanisms and optimism have more influence on the height of expectations than age, gender or baseline function and pain scores.

Methods: A prospective cohort study of 142 patients scheduled for TKA was conducted. Inclusion criteria were Symptomatic and radiographic knee OA indicated for a primary TKA. Exclusion criteria were presence of TKA of the contralateral side, insufficient command of the Dutch language and legally incompetent adults.

Outcome expectations were measured using the HSS knee arthroplasty expectation survey. Independent variables included: age, gender body mass index, pain score, KOOS-PS, OKS and EQ-5D scores, HADS, PCI, LOT-R. Multiple linear regression analyses were used to evaluate associations between these variables with pre-operative outcome expectations.

Results: Highest expectations were scored for improvement of the ability to walk short distances and remove the need for a cane, crutch or walker. Patients had the lowest expectations on the improvement of the ability to kneel or squat after TKA. In the univariate analysis higher depression scores predicted lower expectations on treatment outcome. Because the HADS depression score was the only significant predictor, a multivariate analysis was not performed.

Conclusions: Expectations on treatment outcome after TKA are influenced by the presence of depressive symptoms. Patient demographics and baseline pain and function scores are not related to the height of pre-operative expectations. Because these factors are known to predict treatment outcome, this highlights the potential of improved expectation management

Keywords:
Total knee arthroplasty, Expectations
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