title: Expectations of younger patients concerning activities after knee arthroplasty: are we asking the right questions?
abstract: Indications for total and unicondylar knee arthroplasty (KA) have expanded to younger patients, in which Patient-Reported Outcome Measures (PROMs) often show ceiling effects. This might be due to higher expectations. Our aims were to explore expectations of younger patients concerning activities in daily life, work and leisure time after KA and to assess to what extent PROMs meet and evaluate these activities of importance.
  
  
  
  Focus groups were performed among osteoarthritis (OA) patients <65 years awaiting KA, in which they indicated what activities they expected to perform better in daily life, work and leisure time after KA. Additionally, 28 activities of daily life, 17 of work and 27 of leisure time were depicted from seven PROMS, which were rated on importance, frequency and bother. A total score, representing motivation for surgery, was also calculated.
  
  
  
  Data saturation was reached after six focus groups including 37 patients. Younger OA patients expect to perform better on 16 activities after KA, including high-impact leisure time activities. From the PROMs, daily life and work activities were rated high in both importance and motivation for surgery, but for leisure time activities importance varied highly between patients. All seven PROMs score activities of importance, but no single PROM incorporates all activities rated important.
  
  
  
  Younger patients expect to perform better on many activities of daily life, work and leisure time after KA, and often at demanding levels. To measure outcomes of younger patients, we suggest using PROMs that include work and leisure time activities besides daily life activities, in which preferably scored activities can be individualized.
authors: Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopedic Research Care & Education), Amphia Hospital, Breda, The Netherlands.|Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.|ACES (Academic Center for Evidence - based Sports medicine), Amsterdam, The Netherlands.|ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Amsterdam, The Netherlands.
authors: Suzanne
authors: S
authors: Witjes
authors: Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopedic Research Care & Education), Amphia Hospital, Breda, The Netherlands.
authors: Rutger C I
authors: RC
authors: van Geenen
authors: Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopedic Research Care & Education), Amphia Hospital, Breda, The Netherlands.
authors: Koen L M
authors: KL
authors: Koenraadt
authors: ACES (Academic Center for Evidence - based Sports medicine), Amsterdam, The Netherlands.|Department of Orthopaedic Surgery, Bergman Clinics, Naarden, The Netherlands.
authors: Cor P
authors: CP
authors: van der Hart
authors: Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.|ACES (Academic Center for Evidence - based Sports medicine), Amsterdam, The Netherlands.|ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Amsterdam, The Netherlands.|ORCA (Orthopaedic Research Center Amsterdam), Amsterdam, The Netherlands.
authors: Leendert
authors: L
authors: Blankevoort
authors: Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.|ACES (Academic Center for Evidence - based Sports medicine), Amsterdam, The Netherlands.|ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Amsterdam, The Netherlands.
authors: Gino M M J
authors: GM
authors: Kerkhoffs
authors: Department of Orthopaedic Surgery, Bergman Clinics, Naarden, The Netherlands. p.p.kuijer@amc.uva.nl.|Academic Medical Centre, Coronel Institute of Occupational Health, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands. p.p.kuijer@amc.uva.nl.
authors: P Paul F M
authors: PP
authors: Kuijer
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods / Q000534:rehabilitation*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D017060:Patient Satisfaction; D018434:Sickness Impact Profile; D016896:Treatment Outcome
keywords: Activity; Knee arthroplasty; Knee replacement; PROMs; Patient expectations