Expectation, satisfaction and clinical outcome of patients after total knee arthroplasty

There is a well-known difference between patients expectation, satisfaction and the measured clinical outcome in total knee arthroplasty (TKA). It has been hypothesized that higher expectation prior to surgery and higher satisfaction will show better clinical outcome according to well-established scoring systems, frequently used for assessment after TKA.

A consecutive group of 102 patients was included who received TKA for degenerative osteoarthritis. A modified patients expectation form was used prior and 8 months after surgery. Furthermore, the KSS, WOMAC and SF-36 served for patient assessment. Patients were grouped in responder and non-responder according to their level of expectation and fulfilment of expectation after surgery using a Likert scale.

A total of 54 patients (53%) showed expectation prior to surgery of 1 or 2 and a satisfaction after surgery of 1 or 2 according to the Likert scales. These patients were classified as responders. Considering the continuous parameters of KSS, SF-36 and WOMAC, a few statistically significant differences were found between the responders and non-responders at baseline (pre-surgery) and at the fulfilment of their expectation after surgery. Patient expectation prior to surgery did not differ between both groups. The more satisfied patients showed significant better results in the KSS, WOMAC and SF-36 after surgery. The parameters general health (SF-36) and role emotional (SF-36) measured prior to surgery dominate the predictive potential to get a responder with sensitivity of 74%, specificity of 81% and a rate of correct classification of 78%.

This study has shown that patient satisfaction correlates well with the clinical outcome according to the KSS, WOMAC and SF-36. The indication for TKA should consider the general health, emotional role and knee function of the patients as well in order to predict patient's outcome.