Preoperative Expectations Associated With Postoperative Dissatisfaction After Total Knee Arthroplasty: A Cohort Study
Hassan M. K. Ghomrawi, PhD, MPH, Lily (Yuo-yu) Lee, MS, Benedict U. Nwachukwu, MD, MBA, Deeptee Jain, MD, MPH, Timothy Wright, PhD, Douglas Padgett, MD, Kevin J. Bozic, MD, MBA, and Stephen Lyman, PhDKnee
Introduction:
Unfulfilled expectations, assessed postoperatively, have been consistently associated with dissatisfaction after total knee arthroplasty (TKA). However, identifying these expectations preoperatively has been a challenge. We aimed to identify specific expectations that are most likely to impact postoperative dissatisfaction.
Methods:
We included all patients in our institutional registry with BMI <40 who underwent primary unilateral TKA and had a minimum two-year follow-up. Preoperatively, patients completed the 19-item HSS expectations survey, SF-12, KOOS, and EQ-5D. Two years postoperatively, patients reported their dissatisfaction on 5 domains. We estimated logistic regression models to identify the expectation items associated with each domain.
Results:
2,279 TKA patients (mean age: 65.3±9.2 years; mean BMI: 30.2±5.9 kg/m2) met our inclusion/exclusion criteria. The association between expectations and dissatisfaction was domain-specific, i.e., subsets of 4–5 items were significantly associated with each dissatisfaction domain, and these expectations differed depending on the dissatisfaction domain examined. Of those, expectations predicting dissatisfaction on multiple domains included kneeling ability, and leg straightening as well as participation in recreation and sports.
Conclusion:
We identified a subset of expectations most likely to affect dissatisfaction after TKA. Our findings should inform preoperative patient education approaches on those expectations to realistically orient patient expectations, and increase satisfaction.
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