Patient Expectations Predict Greater Pain Relief with Joint Arthroplasty

https://doi.org/10.1016/j.arth.2008.05.016Get rights and content

Abstract

We examined the relationship between patient expectations of total joint arthroplasty and functional outcomes. We surveyed 1799 patients undergoing primary hip or knee arthroplasty for demographic data and Western Ontario McMaster University Osteoarthritis Index scores at baseline, 3 months, and 1 year of follow-up. Patient expectations were determined with 3 survey questions. The patients with the greatest expectations of surgery were younger, male, and had a lower body mass index. Linear regression modeling showed that a greater expectation of pain relief with surgery independently predicted greater reported pain relief at 1 year of follow-up, adjusted for all relevant covariates (P < .05). Patient expectation of pain relief after joint arthroplasty is an important predictor of outcomes at 1 year.

Section snippets

Study Sample

Study patients were recruited from a single Canadian Academic Institution, the Toronto Western Hospital, before undergoing primary hip or knee arthroplasty. Our inclusion criteria for the study were age of 18 years old and above and a diagnosis of primary or secondary osteoarthritis. All patients gave informed consent to participate in the study. All data were collected by an independent assessor not involved in the medical care of the patients. The study protocol was approved by the local

Results

In our registry, we had complete data on 1799 (76.6%) of 2350 patients that comprised our study cohort. Participants and nonparticipants were not significantly different in terms of age, BMI, sex, or Charlson index.

Demographic data compared across groups defined by the expectations question on time to fully recover from surgery are shown in Table 1. The patients with the lowest expectations were significantly older at a mean age of 73.9 years (P = .04) and more commonly female (P = .02) than

Discussion

Our study demonstrates that patient expectations of joint arthroplasty correlate well with baseline functional status. Our patients had realistic expectations of surgery because those with the best preoperative functional status demonstrated the highest expectations and those with the poorest preoperative function demonstrated the lowest expectations of surgery. We believe that because our patients had set realistic goals for themselves following surgery, we found no difference in level of

References (40)

  • MancusoC.A. et al.

    Patient's expectations of knee surgery

    J Bone Joint Surg Am

    (2001)
  • KatzJ.N. et al.

    Association between hospital and surgeon procedure volume and the outcomes of total knee replacement

    J Bone Joint Surg Am

    (2004)
  • LosinaE. et al.

    Utilization of low-volume hospitals for total hip replacement

    Arthritis Rheum

    (2004)
  • LosinaE. et al.

    Early failures of total hip replacement: effect of surgeon volume

    Arthritis Rheum

    (2004)
  • FortinP.R. et al.

    Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery

    Arthritis Rheum

    (1999)
  • FortinP.R. et al.

    Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee

    Arthritis Rheum

    (2002)
  • LingardE.A. et al.

    Predicting the outcome of total knee arthroplasty

    J Bone Joint Surg Am

    (2004)
  • LingardE.A. et al.

    Impact of psychological distress on pain and function following knee arthroplasty

    J Bone Joint Surg Am

    (2007)
  • Bischoff-FerrariH.A. et al.

    Psychosocial and geriatric correlates of functional status after total hip replacement

    Arthritis Rheum

    (2004)
  • BranderV.A. et al.

    Predicting total knee replacement pain: a prospective, observational study

    Clin Orthop Relat Res

    (2003)
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    No benefits or funds were received in support of the study.

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