title: The importance of patient expectations in predicting functional outcomes after total joint arthroplasty.
abstract: OBJECTIVE
  To evaluate the relationship between patient expectations of total joint arthroplasty (TJA) and health related quality of life plus satisfaction 6 months after surgery. Methods. This prospective cohort study included patients undergoing primary total hip (THA) and knee arthroplasty (TKA). Patients were evaluated with self-report questionnaires prior to surgery and 6 months post-surgery. Medical Outcomes Study Short Form 36 (SF-36), the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), and a satisfaction scale were used to evaluate outcomes at final followup. Multivariate regression models were used to evaluate the impact of expectations on outcomes.
  
  
  RESULTS
  There were 102 patients with THA and 89 with TKA. Mean age was 66 years. All patients achieved significant improvements in their WOMAC and SF-36 scores following surgery. Patient expectations regarding surgery were not associated with their age, gender, index joint of surgery, marital status, or race. Expectations were not correlated with pre-operative functional health status. Expectation of complete pain relief after surgery was an independent predictor of better physical function and improvement in level of pain at 6 months post-surgery. Expectation of low risk of complications from TJA was an independent predictor of greater satisfaction.
  
  
  CONCLUSIONS
  Patient expectations were important independent predictors of improved functional outcomes and satisfaction following TJA. Greater understanding of the relationship between expectations and outcomes may improve the process of care and outcomes of TJA.
authors.affiliation: Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, ON, Canada.
authors.forename: Nizar N
authors.initials: NN
authors.lastname: Mahomed
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Liang
authors.forename: Earl F
authors.initials: EF
authors.lastname: Cook
authors.forename: Lawren H
authors.initials: LH
authors.lastname: Daltroy
authors.forename: Paul R
authors.initials: PR
authors.lastname: Fortin
authors.forename: Anne H
authors.initials: AH
authors.lastname: Fossel
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000534:rehabilitation; D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000534:rehabilitation; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D017060:Patient Satisfaction; D011336:Probability; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome