Sources of Patients' Expectations of Total Knee Arthroplasty

Understanding the sources of patients' expectations of total knee arthroplasty (TKA) can foster realistic expectations. Sources of expectations may be influenced by clinical and psychological variables, including general disposition or attitude.

Patients undergoing TKA completed a 19-item survey preoperatively that addressed the amount of improvement expected (i.e., "complete" to "a little") for symptoms and physical and psychological well-being. Patients reported the sources of these expectations, which were grouped into categories. Disposition or attitude was assessed for positive affect (e.g., openness to change) and negative affect (e.g., irritability) with use of the Positive and Negative Affect Schedule (PANAS). Clinical status was assessed using the Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR). Expectations and sources of expectations were compared with KOOS-JR and PANAS scores and demographic and clinical characteristics (e.g., symptom duration) with use of statistical analyses.

A total of 232 patients (mean age, 65 years; 60% women; 17% Latino ethnicity or non-White race) were enrolled 17 ± 8 days preoperatively. Seventy-two percent expected ≥15 of the survey items; complete improvement was expected for 59% of items. Expecting more items was associated with better preoperative KOOS-JR scores (p < 0.0001), more negative affect (p = 0.003), a shorter duration of symptoms (p = 0.01), and not being a college graduate (p = 0.04). Patients volunteered multiple sources of expectations, including favorable outcomes from a previous orthopaedic surgery (11% of patients), knowledge of favorable (56%) and unfavorable (7%) TKA outcomes in others, their current surgeon (15%), avoidance of further knee deterioration (10%), internet information (16%), and general optimism (18%). Citing more sources was associated with worse KOOS-JR scores (p = 0.02) and less positive affect (p = 0.009). Sources of expectations were associated with patient variables; specifically, knowledge of favorable outcomes was associated with better KOOS-JR scores (p = 0.04), knowledge of unfavorable outcomes was associated with more negative affect (p = 0.04), optimism was associated with more positive affect (p = 0.01), and information from the internet was associated with longer symptom duration (p = 0.04) and less negative affect (p = 0.02).

Patients had high expectations of TKA and derived these expectations from diverse sources spanning personal and social network experiences. Patients' expectations and/or sources of expectations were associated with functional status and positive and negative affect.

Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.