Changes in Expectation Fulfillment Following Total Knee Arthroplasty: A 10-Year Follow-Up Study

This study aims to investigate how expectation fulfillment changes up to 10 years following total knee arthroplasty (TKA).

Preoperative data were collected for 323 patients undergoing TKA (Hospital for Special Surgery Knee Replacement Expectations survey, Oxford Knee Score [OKS], and Short Form [SF]-12). Expectation fulfillment, OKS, SF-12, and patient satisfaction were assessed at 1 year and 9-10 years postoperatively. Relative risk (RR) of dissatisfaction at late follow-up was calculated for each specific expectation question. Linear regression analysis was used to identify factors independently associated with early (1 year) and late (mean 9 years) expectation fulfillment scores.

Mean expectation fulfillment scores declined from early to late follow-up (25.9-23.9, P = .025). Multivariate analysis identified younger age and better 1-year OKS as factors independently associated with long-term expectation fulfillment. Twelve percent of patients reported dissatisfaction at late follow-up. The risk of long-term dissatisfaction was greatest in patients with high preoperative expectations of kneeling (RR 2.2, 95% confidence interval [CI] 0.9-5.5), walking without aids (RR 2.4, 95% CI 0.7-7.6), and improved psychological well-being (RR 3.9, 95% CI 0.9-5.0). Night pain relief, kneeling ability, participating in outside activities, and sports were the most poorly fulfilled expectations at both early and late time points. Fulfillment improved the least from early to late for kneeling ability (17%) and ability to participate in outside activities (17%).

Expectation fulfillment following TKA changes with time. Expectations of kneeling ability and the ability to perform outside activities demonstrated persistently low levels of fulfillment. This information can be used to manage the longer term expectations of patients undergoing TKA.