Expectations before periacetabular osteotomy and relation to post-operative outcomes and satisfaction

A periacetabular osteotomy (PAO) seeks to improve native hip function in patients with pre-arthritic dysplasia. Fulfilment of expectations has been shown to influence post-operative satisfaction in spine surgery and knee arthroplasty, but has not been investigated for PAOs. This study analyses relationships between preoperative patient expectations, patient-reported outcomes, and patient satisfaction in young adults undergoing PAO. Patients undergoing PAO in 2012-2014 at a tertiary care centre were asked to complete a preoperative survey indicating their expectations on a Likert scale (not improved-greatly improved) in six domains: pain, stability, stiffness, walking, locking/catching, and athletics. At 7-9 years after PAO, patients reported outcomes on the same Likert scales. Patients were also asked about satisfaction (very dissatisfied-very satisfied) in each domain and overall helpfulness of the PAO (extremely unhelpful-extremely helpful). Change between preoperative expectation and long-term outcome was assessed using the Wilcoxon signed rank test for paired ordinal data. The association between expectations/outcomes alignment with satisfaction and perceived helpfulness of PAO was assessed with Spearman rank correlation. Alignment between patient expectations and long-term outcomes correlated with long-term satisfaction for all domains, with the strongest correlation in the pain domain. Alignment between patient expectations and long-term outcomes also correlated with perceived helpfulness of the PAO for all domains except for walking ability and stiffness. Regardless of preoperative expectation level, patients whose expectations align with their outcomes are generally more satisfied and perceive their procedure as more helpful compared with those with misaligned expectations and outcomes.