Outcome Measures in Total Joint Arthroplasty: Current Status, Challenges, and Future Directions

Total joint arthroplasty (TJA) is the most commonly performed surgical procedure for the treatment of advanced degenerative joint diseases. Numerous outcome measures for TJA have been developed, which can be reported by physicians, patients, or both. Although outcome tools were traditionally centered on morbidity, mortality, and implant survival, the focus has evolved over recent years to joint-specific, disease-specific, activity-specific, general well-being, and quality of life assessments. However, despite the importance of outcome measures in a time of growing demand for TJA and increased government scrutiny fueled by high implant costs, there remains no "gold standard" method to assess the impact of TJA. The aim of this review is to evaluate the currently available literature on outcome measures in joint arthroplasty, highlighting the strengths and limitations of commonly used instruments. Because outcomes are influenced by a multitude of intangible factors, there is an increasing role for assessing patient satisfaction as a simple way to account for the complex aspects of care. Strategies including proper patient selection and establishing realistic expectations preoperatively are critical to optimizing outcomes. In an era of increasing public scrutiny, the current state of conflicting results and variable correlations among outcome measures implores the need for a standardized system that should incorporate a metric for patient satisfaction adjusted for preoperative expectations.