Patient expectation fulfilment following total hip arthroplasty: a 10-year follow-up study

Background

The primary aim of this study was to assess how expectation fulfilment changes up to 10 years following total hip arthroplasty (THA).

Materials and methods

Three hundred and forty-six patients completed an expectation questionnaire (encompassing 18 activities), Oxford hip score (OHS) and Short Form (SF)-12 prior to surgery. At 1 year postoperatively, expectation fulfilment was assessed in addition to OHS, SF-12 and patient satisfaction (n = 346). This was repeated in surviving patients with intact THAs at 9.1–9.9 years postoperative (n = 224). Linear regression analysis was used to identify factors independently associated with early (1 year) and late (mean 9.5 years) expectation fulfilment.

Results

Postoperative expectation fulfilment scores declined from 36.5 at 1 year to 33 at late follow-up (95% confidence intervals (CI) 0.0–5.0, p < 0.001). Increased (better) late expectation fulfilment scores were significantly associated with better scores for all PROMs applied at both timepoints. Younger age, greater pre-operative expectation score and greater improvement in OHS (both early and late) were all independent predictors when adjusting for confounding (p < 0.05). At late follow-up 78% (14/18) activities demonstrated high levels of persistent expectation fulfilment. Approximately two out of every five patients who considered themselves unfulfilled at early follow-up went on to experience late fulfilment, but this was dependent upon the specific expectation (mean 40%, range 0–64%).

Conclusions

Expectation fulfilment following THA changes with time. The majority of patients report high levels of expectation fulfilment following THA at late follow-up. This information can be used to help manage the longer-term expectations of patients undergoing THA.