title: Higher Patient Expectations Predict Higher Patient-Reported Outcomes, But Not Satisfaction, in Total Knee Arthroplasty Patients: A Prospective Multicenter Study.
abstract: The relationship between patient expectations, patient-reported outcomes (PROs), and satisfaction in total knee arthroplasty (TKA) patients is not well understood.
  
  
  
  We prospectively evaluated patients who underwent primary TKA at 4 institutions. Demographics were collected. Preoperatively, patients completed the Hospital for Special Surgery Knee Replacement Expectations Survey (HSS-KRES), SF-12, UCLA activity, and Knee Disability and Osteoarthritis Score. At 6 months and 1 year postoperatively, patients completed the Hospital for Special Surgery Knee Replacement Fulfillment of Expectations Survey (HSS-KRFES), a satisfaction survey, and PROs. Step-wise multivariate regression models were created.
  
  
  
  Eighty-three patients were enrolled. At 6 months and 1 year postoperatively, the follow-up rate was 84.3% and 92.7%, respectively. No demographics or preoperative PROs were predictive of HSS-KRES. Preoperative HSS-KRES did not predict postoperative satisfaction, but higher HSS-KRES predicted higher HSS-KRFES at 1 year, greater improvement in UCLA activity at 6 months and 1 year, and SF-12 Physical Composite Scale and Knee Disability and Osteoarthritis Score at 6 months. Higher HSS-KRFES predicted higher satisfaction at 6 months and 1 year.
  
  
  
  In TKA patients, preoperative expectations are not influenced by patient demographics or preoperative function. Higher preoperative expectations predict greater postoperative improvement in PROs and fulfillment of expectations. These findings highlight the importance of preoperative patient expectations on postoperative outcome.
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Deeptee
authors.initials: D
authors.lastname: Jain
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Long-Co L
authors.initials: LL
authors.lastname: Nguyen
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Ilya
authors.initials: I
authors.lastname: Bendich
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Long L
authors.initials: LL
authors.lastname: Nguyen
authors.affiliation: Orthopaedic Associates of Hartford, Hartford, Connecticut.
authors.forename: Courtland G
authors.initials: CG
authors.lastname: Lewis
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Palo Alto, California.
authors.forename: James I
authors.initials: JI
authors.lastname: Huddleston
authors.affiliation: Orthopaedic Fracture Specialists, Portland, Oregon.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Duwelius
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Feeley
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California; Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bozic
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D057234:Preoperative Period; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: health outcomes; patient expectations; patient satisfaction; patient-reported outcomes; total knee arthroplasty