title: Discordance in TKA expectations between patients and surgeons.
abstract: BACKGROUND
  Aligning patient and surgeon expectations preoperatively may lead to better postoperative medical and rehabilitation compliance and therefore improve outcomes and increase satisfaction.
  
  
  OBJECTIVE
  We (1) determined the rate of discordantly high patient expectations compared with those of their surgeon in patients undergoing TKA; and (2) evaluated the impact of the preoperative educational class, patient characteristics, and functional status on the likelihood of having discordantly high patient expectations.
  
  
  METHODS
  We enrolled 205 patients awaiting TKA. Each patient completed a validated questionnaire that addresses expectations of postoperative pain relief, function, and well-being as part of a preoperative assessment. The surgeon completed the same expectations questionnaire preoperatively blinded to their patient's response. Patients had discordantly high expectations if their scores were ≥ 7 points higher than the surgeon on a 0 to 100 score range. Regression analysis was performed to determine the effect of class, patient characteristics, and functional status on the likelihood of having discordantly high patient expectations.
  
  
  RESULTS
  Thirty-seven percent of the patients had expectation scores ≥ 7 points higher than those of their surgeon. Patients were less likely to have discordantly higher expectations if they were female (OR, 0.56; CI, 0.32-0.97) and if their pain level was high (OR, 0.99; CI, 0.98-0.99). Patients were more likely to have discordantly higher expectations if they filled out the expectations survey before rather than after the preoperative educational class (OR, 1.80; CI, 1.08-3.01).
  
  
  CONCLUSIONS
  With increasing TKA use, surgeons will likely encounter more patients with discordantly high expectations. The preoperative educational class can be used to target patients more likely to have discordantly high expectations.
authors: Department of Public Health, Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065, USA. hag2008@med.cornell.edu
authors: Hassan M K
authors: HM
authors: Ghomrawi
authors: Carol A
authors: CA
authors: Mancuso
authors: Geoffrey H
authors: GH
authors: Westrich
authors: Robert G
authors: RG
authors: Marx
authors: Alvin I
authors: AI
authors: Mushlin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011300:Preoperative Care; D011446:Prospective Studies; D020127:Recovery of Function; D012737:Sex Factors; D016896:Treatment Outcome