J Knee Surg 2021; 34(06): 612-620
DOI: 10.1055/s-0039-1698805
Original Article

Preoperative Expectations of Patients Undergoing Knee Surgery

Kali N. Stevens
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
2   Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate College of Medicine, Brooklyn, New York
,
Julio J. Jauregui
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Xuyang Song
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Shaun H. Medina
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Michael P. Smuda
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Jonathan D. Packer
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
R. Frank Henn 3rd
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
› Author Affiliations
Funding This work was supported by a grant from The James Lawrence Kernan Hospital Endowment Fund, Incorporated.

Abstract

There is limited validated data regarding the relationship between preoperative expectations and patient-reported outcomes (PROs) in patients undergoing knee surgery. The purpose of this study was to (1) assess the preoperative expectations of patients undergoing knee surgery and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. We hypothesized that younger patients with worse function and worse general health status would have greater expectations of knee surgery. We analyzed data from 399 patients undergoing knee surgery at an urban academic medical center. We utilized the Musculoskeletal Outcomes Data Evaluation and Management System to measure preoperative expectations. Multiple legacy PRO measures were recorded, as well as the new Patient-Reported Outcomes Measurement Information Systems (PROMIS) Computer Adaptive Testing. Nonparametric statistical analyses were performed to determine significance. Overall, patients undergoing knee surgery had high expectations, with a mean of 88.0 (95% confidence interval [CI], 86.7–89.3) and median of 91.7 (95% CI, 89.2–94.3). Greater preoperative expectations of knee surgery were associated with higher income, surgically naïve knee, lower Charlson Comorbidity Index, better PROMIS Depression and Anxiety scores, greater Marx knee activity scores, and lower total body pain (p < 0.05). Preoperative expectations of patients undergoing knee surgery are associated with a history of prior knee surgery, income, general and mental health, activity, and pain. Expectations were also found to be associated with PRO measures of function and psychological well-being. These findings may have implications for patient education and shared decision-making preoperatively. The level of evidence for the study is IV.

Note

This study was presented at the Arthroscopy Association of North America Annual Meeting 2018; Scientific Session: General Knee, SS-80.


The study was approved by the Institutional Review Board (IRB) at the University of Maryland, Baltimore (HP-00062261).




Publication History

Received: 02 May 2019

Accepted: 01 September 2019

Article published online:
22 October 2019

© 2019. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Losina E, Thornhill TS, Rome BN, Wright J, Katz JN. The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic. J Bone Joint Surg Am 2012; 94 (03) 201-207
  • 2 Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 2011; 93 (11) 994-1000
  • 3 Zywiel MG, Mahomed A, Gandhi R, Perruccio AV, Mahomed NN. Measuring expectations in orthopaedic surgery: a systematic review. Clin Orthop Relat Res 2013; 471 (11) 3446-3456
  • 4 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
  • 5 Culliton SE, Bryant DM, Overend TJ, MacDonald SJ, Chesworth BM. The relationship between expectations and satisfaction in patients undergoing primary total knee arthroplasty. J Arthroplasty 2012; 27 (03) 490-492
  • 6 Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 2006; 452 (452): 35-43
  • 7 Scott CE, Bugler KE, Clement ND, MacDonald D, Howie CR, Biant LC. Patient expectations of arthroplasty of the hip and knee. J Bone Joint Surg Br 2012; 94 (07) 974-981
  • 8 Soroceanu A, Ching A, Abdu W, McGuire K. Relationship between preoperative expectations, satisfaction, and functional outcomes in patients undergoing lumbar and cervical spine surgery: a multicenter study. Spine 2012; 37 (02) E103-E108
  • 9 Henn III RF, Ghomrawi H, Rutledge JR, Mazumdar M, Mancuso CA, Marx RG. Preoperative patient expectations of total shoulder arthroplasty. J Bone Joint Surg Am 2011; 93 (22) 2110-2115
  • 10 Tashjian RZ, Bradley MP, Tocci S, Rey J, Henn RF, Green A. Factors influencing patient satisfaction after rotator cuff repair. J Shoulder Elbow Surg 2007; 16 (06) 752-758
  • 11 Fidai MS, Saltzman BM, Meta F. et al. Patient-reported outcomes measurement information system and legacy patient-reported outcome measures in the field of orthopaedics: a systematic review. Arthroscopy 2017; DOI: 10.1016/j.arthro.2017.07.030.
  • 12 Henn III RF, Dubina AG, Jauregui JJ, Smuda MP, Tracy JK. The Maryland Orthopaedic Registry (MOR): design and baseline characteristics of a prospective registry. J Clin Orthop Trauma 2017; 8 (04) 301-307
  • 13 Ho B, Houck JR, Flemister AS. et al. Preoperative PROMIS scores predict postoperative success in foot and ankle patients. Foot Ankle Int 2016; 37 (09) 911-918
  • 14 Wong SE, Zhang AL, Berliner JL, Ma CB, Feeley BT. Preoperative patient-reported scores can predict postoperative outcomes after shoulder arthroplasty. J Shoulder Elbow Surg 2016; 25 (06) 913-919
  • 15 Berliner JL, Brodke DJ, Chan V, SooHoo NF, Bozic KJ. Can preoperative patient-reported outcome measures be used to predict meaningful improvement in function after TKA?. Clin Orthop Relat Res 2017; 475 (01) 149-157
  • 16 Berliner JL, Brodke DJ, Chan V, SooHoo NF, Bozic KJ. John Charnley Award: preoperative patient-reported outcome measures predict clinically meaningful improvement in function after THA. Clin Orthop Relat Res 2016; 474 (02) 321-329
  • 17 Papuga MO, Beck CA, Kates SL, Schwarz EM, Maloney MD. Validation of GAITRite and PROMIS as high-throughput physical function outcome measures following ACL reconstruction. J Orthop Res 2014; 32 (06) 793-801
  • 18 Nadarajah V, Glazier E, Miller K. et al. Evaluation of preoperative pain using PROMIS pain interference in knee surgery patients. J Knee Surg 2020; 33 (09) 875-883
  • 19 Miles M, Nadarajah V, Jauregui JJ. et al. Evaluation of the PROMIS physical function computer adaptive test in patients undergoing knee surgery. J Knee Surg 2020; 33 (08) 810-817
  • 20 Medina SH, Nadarajah V, Jauregui JJ. et al. Orthopaedic surgery patients who use recreational marijuana have less pre-operative pain. Int Orthop 2019; 43 (02) 283-292
  • 21 Meredith SJ, Nadarajah V, Jauregui JJ. et al. Preoperative opioid use in knee surgery patients. J Knee Surg 2019; 32 (07) 630-636
  • 22 Hancock KJ, Glass N, Anthony CA. et al. Performance of PROMIS for healthy patients undergoing meniscal surgery. J Bone Joint Surg Am 2017; 99 (11) 954-958
  • 23 Hancock KJ, Glass N, Anthony CA. et al. PROMIS: a valid and efficient outcomes instrument for patients with ACL tears. Knee Surg Sports Traumatol Arthrosc 2019; 27 (01) 100-104
  • 24 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
  • 25 Henn III RF, Kang L, Tashjian RZ, Green A. Patients' preoperative expectations predict the outcome of rotator cuff repair. J Bone Joint Surg Am 2007; 89 (09) 1913-1919
  • 26 Levin J. Elementary Statistics in Social Research: The Essentials. 2nd ed. Boston: Pearson Education; 2006
  • 27 Mukaka MM. Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J 2012; 24 (03) 69-71
  • 28 Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; hospital inpatient value-based purchasing program. Final rule. Fed Regist 2011; 76 (88) 26490-26547
  • 29 Centers for Medicare & Medicaid Services (CMS), HHS. Medicare Program; comprehensive care for joint replacement payment model for acute care hospitals furnishing lower extremity joint replacement services. Final rule. Fed Regist 2015; 80 (226): 73273-73554
  • 30 Brophy RH, Gefen AM, Matava MJ, Wright RW, Smith MV. Understanding of meniscus injury and expectations of meniscus surgery in patients presenting for orthopaedic care. Arthroscopy 2015; 31 (12) 2295-300.e5
  • 31 Pihl K, Roos EM, Nissen N, JøRgensen U, Schjerning J, Thorlund JB. Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery. Acta Orthop 2016; 87 (06) 615-621
  • 32 Matava MJ, Howard DR, Polakof L, Brophy RH. Public perception regarding anterior cruciate ligament reconstruction. J Bone Joint Surg Am 2014; 96 (10) e85
  • 33 Tilbury C, Haanstra TM, Leichtenberg CS. et al. Unfulfilled expectations after total hip and knee arthroplasty surgery: there is a need for better preoperative patient information and education. J Arthroplasty 2016; 31 (10) 2139-2145
  • 34 Nilsdotter AK, Toksvig-Larsen S, Roos EM. Knee arthroplasty: are patients' expectations fulfilled? A prospective study of pain and function in 102 patients with 5-year follow-up. Acta Orthop 2009; 80 (01) 55-61
  • 35 Mancuso CA, Sculco TP, Salvati EA. Patients with poor preoperative functional status have high expectations of total hip arthroplasty. J Arthroplasty 2003; 18 (07) 872-878
  • 36 Riddle DL, Golladay GJ, Hayes A, Ghomrawi HM. Poor expectations of knee replacement benefit are associated with modifiable psychological factors and influence the decision to have surgery: a cross-sectional and longitudinal study of a community-based sample. Knee 2017; 24 (02) 354-361
  • 37 Swarup I, Henn CM, Nguyen JT. et al. Effect of pre-operative expectations on the outcomes following total shoulder arthroplasty. Bone Joint J 2017; 99-B (09) 1190-1196
  • 38 Dunn WR, Kuhn JE, Sanders R. et al; MOON Shoulder Group. 2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. J Shoulder Elbow Surg 2016; 25 (08) 1303-1311
  • 39 Mondloch MV, Cole DC, Frank JW. Does how you do depend on how you think you'll do? A systematic review of the evidence for a relation between patients' recovery expectations and health outcomes. CMAJ 2001; 165 (02) 174-179
  • 40 Dyck BA, Zywiel MG, Mahomed A, Gandhi R, Perruccio AV, Mahomed NN. Associations between patient expectations of joint arthroplasty surgery and pre- and post-operative clinical status. Expert Rev Med Devices 2014; 11 (04) 403-415
  • 41 Mancuso CA, Altchek DW, Craig EV. et al. Patients' expectations of shoulder surgery. J Shoulder Elbow Surg 2002; 11 (06) 541-549
  • 42 Rauck RC, Swarup I, Chang B. et al. Effect of preoperative patient expectations on outcomes after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27 (11) e323-e329