title: Poor expectations of knee replacement benefit are associated with modifiable psychological factors and influence the decision to have surgery: A cross-sectional and longitudinal study of a community-based sample.
abstract: BACKGROUND
  Total knee arthroplasty (TKA) is a highly effective surgery, but is underutilized by some patient groups. This study determined factors associated with a person's expectations with respect to pain and walking function following a TKA procedure, should they elect to undergo a TKA.
  
  
  METHODS
  A total of 3542 people were studied with or at risk of knee osteoarthritis and enrolled in the community-based Osteoarthritis Initiative (OAI). Multivariable logistic regression analyses identified demographic, socioeconomic, osteoarthritis-related, joint replacement awareness, and psychological correlates as poor outcome expectations. Logistic regression determined if outcome expectation was associated with future knee arthroplasty utilization.
  
  
  RESULTS
  Approximately 25% of the sample expected a poor outcome. Several factors were associated with poor pain outcome expectation, with the most powerful being African American race (Odds Ratio (OR)=2.11, 95% CI=1.69, 2.64) and an interaction between clinical depression symptoms and pain catastrophizing (OR=3.17, 95% CI=2.26, 4.44 when both were coded 'yes'). Whether a person had knee OA did not affect expectations. Pain outcome expectations were strongly associated with future TKA utilization (OR=4.9, 95% CI=2.2, 11.1).
  
  
  CONCLUSIONS
  A variety of modifiable psychological factors impact people's expectations of the extent of pain and walking difficulty following a potential future TKA. Expectations strongly predict future TKA utilization. Given the high prevalence of knee osteoarthritis, mass media educational interventions for the population may assist in better aligning expectations with evidence-based knee arthroplasty outcomes and lead to more appropriate utilization of an effective procedure.
authors.affiliation: Department of Physical Therapy, School of Allied Health Professions, USA; Department of Orthopaedic Surgery, School of Medicine, Virginia Commonwealth University, USA. Electronic address: dlriddle@vcu.edu.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Riddle
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Virginia Commonwealth University, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Golladay
authors.affiliation: Division of Comparative Effectiveness and Outcomes Research, Department of Healthcare Policy and Research, Weill Medical College, Cornell University, USA; Healthcare Research Institute, Hospital for Special Surgery, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Hayes
authors.affiliation: Division of Comparative Effectiveness and Outcomes Research, Department of Healthcare Policy and Research, Weill Medical College, Cornell University, USA; Healthcare Research Institute, Hospital for Special Surgery, USA.
authors.forename: Hassan M K
authors.initials: HMK
authors.lastname: Ghomrawi
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000523:psychology / Q000601:surgery*; D012111:Residence Characteristics
keywords: Arthroplasty; Expectation; Knee; Outcome