title: Pre-operative expectation predicts 12-month post-operative outcome among patients undergoing primary total hip replacement in European orthopaedic centres.
abstract: OBJECTIVE
  Patients' expectations of surgery may be related to outcomes of joint replacement. The aims of this study were to: (1). Identify patient characteristics associated with pre-operative expectations of total hip replacement (THR); (2). Explore whether pre-operative expectations predict surgical outcomes 12-months post-THR.
  
  
  METHODS
  The European collaborative database of cost and practice patterns of THR (EUROHIP) study consists of 1327 consenting patients coming to primary THR for osteoarthritis (OA) across 20 European orthopaedic centres. Ordered logistic regression modelling was used to look at the association between patients pre-operative expectations and baseline characteristics (age, sex, education, American Society of Anaesthesiologists (ASA) status, Kellgren & Lawrence (K&L) grade, body mass index (BMI), medication use, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, EQ5D (EuroQol) score). The Outcome Measures in Rheumatology (OMERACT)/Osteoarthritis Research Society International (OARSI) responder criteria were used to classify patients as improved/not improved 12-months post-THR. Logistic regression modelling was used to explore whether pre-operative expectations predict response to THR.
  
  
  RESULTS
  Greater numbers of pre-operative expectations were associated with younger age, women, increasing BMI, and more education. The more pre-operative expectations a patient had, the more likely they were to improve after surgery. Each individual expectation a patient had, was associated with a 34% increase in improvement [95% confidential interval (CI) 1%-78%]. Analyses within dimensions of the WOMAC suggest the association is strongest for stiffness and function.
  
  
  CONCLUSIONS
  There is large variation in patients' pre-operative expectations of THR. Greater numbers of pre-operative expectations were associated with improvement following THR. This appears to be driven more by stiffness and function. These findings have implications for informed patient-clinician decision-making.
authors: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK. Andrew.Judge@ndorms.ox.ac.uk
authors: A
authors: A
authors: Judge
authors: C
authors: C
authors: Cooper
authors: N K
authors: NK
authors: Arden
authors: S
authors: S
authors: Williams
authors: N
authors: N
authors: Hobbs
authors: D
authors: D
authors: Dixon
authors: K-P
authors: KP
authors: Günther
authors: K
authors: K
authors: Dreinhoefer
authors: P A
authors: PA
authors: Dieppe
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D001294:Attitude to Health; D015992:Body Mass Index; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000523:psychology*; D012720:Severity of Illness Index; D012737:Sex Factors