title: Why two-thirds of patients accepted the second session in staged bilateral total knee arthroplasty: a prospective analysis of 111 patients.
abstract: OBJECTIVE
  In staged bilateral total knee arthroplasty (TKA), regaining functional recovery and a painless joint with fulfilment of patients' expectations at the first stage is an integral part for a patient to progress to the second stage. As patient expectations drive postoperative satisfaction, the challenge is to match patient and surgeon expectations before surgery. Therefore, this study aimed to evaluate the postoperative patient expectations and clinical outcomes and to evaluate the rate of second stage in bilateral staged TKA.
  
  
  METHODS
  The study included 111 patients; 81 females and 30 males with a median age at surgery of 68 years (range 59-85 years) and 46 were older than 70 years. Postoperative functional data included Knee Society Scores (KSS). Expectation data were collected according to the post-visit 'Questionnaire of Patient Expectations of Healthcare'.
  
  
  RESULTS
  The overall refusal rate for the second stage was 36.9 % (n = 41). The patients older than 70 years had a higher refusal rate compared to relatively younger patients (< 70 years old) (p = 0.038). Younger age, postoperatively improved KSS, fulfilment of patient expectations of the healthcare process, treatment outcomes and whole expectations were the main determinants for patients accepting the second stage. The most important determinative factors for attendance were 'Process of Healthcare' and subsequently 'Treatment Outcomes' and total questionnaire scores (p < 0.001).
  
  
  CONCLUSIONS
  The postoperative perception of healthcare and the treating surgeon's knowledge and responsivity are the major concerns for patients considering second stage TKA.
  
  
  METHODS
  III.
authors.affiliation: Department of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ardahan S no 25 Kecioren, 06380, Ankara, Turkey. drsesen@hotmail.com.
authors.forename: Hakan
authors.initials: H
authors.lastname: Sesen
authors.affiliation: Department of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ardahan S no 25 Kecioren, 06380, Ankara, Turkey. drismail@yahoo.com.
authors.forename: Ismail
authors.initials: I
authors.lastname: Demirkale
authors.affiliation: Department of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ardahan S no 25 Kecioren, 06380, Ankara, Turkey. mertkaraduman@gmail.com.
authors.forename: Mert
authors.initials: M
authors.lastname: Karaduman
authors.affiliation: Department of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ardahan S no 25 Kecioren, 06380, Ankara, Turkey. alpcelal@gmail.com.
authors.forename: Celal Alp
authors.initials: CA
authors.lastname: Vural
authors.affiliation: Department of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ardahan S no 25 Kecioren, 06380, Ankara, Turkey. canerokkaoglu@yahoo.com.
authors.forename: Mustafa Caner
authors.initials: MC
authors.lastname: Okkaoglu
authors.affiliation: Department of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ardahan S no 25 Kecioren, 06380, Ankara, Turkey. muraltay@yahoo.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Altay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000523:psychology*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000523:psychology* / Q000601:surgery*; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D011446:Prospective Studies; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Bilateral gonarthrosis; Patient expectations; Staged; Total knee arthroplasty