Patient Personality Influences Early Overall Satisfaction Following Primary Total Hip and Knee Arthroplasty

Up to 20% of patients report dissatisfaction following primary total joint arthroplasty (TJA). Patient characteristics, surgical techniques, and clinical outcomes do not fully explain dissatisfaction. Dispositional personality traits are related to health behaviors and outcomes. We evaluated the relationship between patient personality and early overall satisfaction after TJA.

Elective unilateral primary TJAs (n = 377) were prospectively enrolled. The sample consisted of 61% women, with an average age and body mass index of 67 years (range, 31 to 89) and 35 (range, 15 to 62), respectively. A validated personality assessment was administered preoperatively. Satisfaction was measured at a mean of 4.8 (range, 2.5 to 6.4) months postoperatively, as were other covariates, including whether expectations for pain and functional improvement were met, joint health scores, mental and physical health, and health literacy. Patient sex, race, age, body mass index, American Society of Anesthesiologists Physical Status classification, surgeon, procedure type, and complications within 90 days of surgery also served as covariates. Variables significantly related to being satisfied with TJA were analyzed using binary logistic regression.

Patient-reported satisfaction was 80% for improvement in recreational activities, 86% for improvement in the ability to perform housework and yardwork, and 93% for pain relief and the overall result of surgery. In multivariable analyses, each unit increase in the personality trait open-mindedness increased overall and pain relief satisfaction by 3.87 and 2.65 times, respectively (P ≤ 0.012), as did each unit increase in expectations being met (2.33 and 5.87 times, respectively, P ≤ 0.001). The area under the receiver operating characteristic curve statistics indicated that accounting for open-mindedness enhanced the classification of satisfied and not satisfied patients beyond accounting for whether expectations were met.

Patient personality influences early patient-reported satisfaction after TJA, warranting careful consideration when using this metric to assess surgical effectiveness and reimbursement.