Do Surgeon Expectations Predict Clinically Important Improvements in WOMAC Scores After THA and TKA?
Hassan M K Ghomrawi1,2,3, Carol A Mancuso4, Allison Dunning5
1Department of Surgery, Feinberg School of Medicine, Northwestern University, 20th Floor, 633 N Saint Claire, Chicago, IL, 60611, USA. hassan.ghomrawi1@northwestern.edu.
Clinical Orthopaedics and Related Research
|March 30, 2017
Summary
Surgeons accurately predicted patient benefit after hip replacement (THA) but not knee replacement (TKA). More surgeon-patient discussion is needed, especially for TKA patients, to manage expectations and improve outcomes.
Area of Science:
- Orthopaedic Surgery
- Patient-Reported Outcomes
- Surgical Decision Making
Background:
- Patient expectations significantly influence satisfaction after total hip arthroplasty (THA) and total knee arthroplasty (TKA).
- Discrepancies between patient expectations and surgical outcomes can lead to disappointment and litigation.
- Surgeons' ability to accurately predict which patients will benefit from THA/TKA is not well-established.
Purpose of the Study:
- To assess surgeons' accuracy in predicting patient benefit from THA and TKA prior to surgery.
- To determine if surgeons can identify patients unlikely to achieve a clinically important improvement in pain and function.
Main Methods:
- Prospective study involving 8 high-volume orthopaedic surgeons assessing patient expectations for THA/TKA.
- Patients completed WOMAC (Western Ontario and McMaster Universities Arthritis Index) preoperatively and at 2-year follow-up.
- Receiver operating characteristic (ROC) curves analyzed the predictive accuracy of surgeons' expectation scores for achieving minimum clinically important difference (MCID).
Main Results:
- Surgeons' expectations accurately predicted improvement in THA patients (ROC AUC 0.67-0.74).
- Surgeons' predictions for TKA patients were no better than chance (ROC AUC ~0.51 for pain and function).
- Predictive accuracy for THA was higher for men, patients with BMI <30, multiple comorbidities, and those over 65.
Conclusions:
- While most THA and TKA patients achieve significant improvement, surgeons struggle to predict outcomes for certain TKA patients.
- Enhanced surgeon-patient communication and standardized expectation assessment tools are crucial.
- Addressing patient needs and expectations proactively can improve satisfaction and potentially reduce litigation.
