Patient expectations and health-related quality of life outcomes following total joint replacement

Patient psychological factors have been linked to health-related quality of life (HRQoL) outcomes after total joint replacement (TJR). We evaluated the relationship between patient expectations before TJR, their fulfillment and HRQoL outcomes at 3 and 12 months after surgery.

Consecutive patients preparing for TJR of the knee or hip due to primary osteoarthritis in 15 hospitals in Spain were recruited for the study. Patients completed questionnaires before surgery, and 3 and 12 months afterward: five questions about expectations before surgery and their fulfillment at 3 and 12 months; three HRQoL instruments-Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form 12 (SF-12), and European Quality of Life Instrument (EQ-5D); as well as questions about sociodemographic information. Student's t test was used to assess the relationship between fulfillment of expectations and gains in HRQoL.

A total of 881 patients took part in the study. Preintervention expectations for TJR ranged from 85% to 86% of patients, with high expectations for pain relief and ability to walk to 70% with high expectations about interacting with others. Patients who reported having fulfilled their expectations at 3 and 12 months had significantly greater gains in HRQoL than those who did not. Besides, we observed a statistically significant improvement in the percentage of patients who fulfill their expectations from 3 to 12 months.

Patients have high expectations for the benefits of TJR, and those who fulfill their expectations have greater gains in HRQoL assessing by SF-12, WOMAC and EQ-5D. Health-care providers should help their patients develop realistic expectations about the impact of TJR.