Do Patients Have Unrealistic Surgery Expectations? Yes. They Do.

Using the Hospital for Special Surgery Knee Replacement Expectation Score, researchers from Scotland assessed the pre- and postoperative expectations of 200 patients from varying socioeconomic backgrounds.

The resulting study, “Fulfilment of preoperative expectations and postoperative patient satisfaction after total knee replacement. A prospective analysis of 200 patients,” appears in the August 29, 2019 edition of The Knee.

Co-author Martin Sarungi, M.D., Ph.D., with the Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK told OTW that the idea for this study came from the stubborn fact that many patients are not entirely happy with their knee surgery. “There is a steady number of patients who are not fully satisfied after knee replacement surgery, even though the operation is technically successful and the indication for operation is correct (e.g. bone on bone advanced osteoarthritis [OA]). Therefore, we tried to analyse the role of preoperative expectations and unfulfilled expectations in relation to patient satisfaction.”

And what did the authors learn? They found that, at six weeks, 30% of the patient’s expectations were fulfilled, increasing to 48% at one year. Corresponding satisfaction rates were 84% and 89%. The research team also saw evidence that higher fulfilment scores were associated with greater satisfaction and, more to the point, meeting the patient’s pain and mobility expectations were the strongest predictors of overall satisfaction. Expectations of kneeling, squatting, paid work and sexual function, unfortunately, were not as well fulfilled.

Finally, the team found that preoperative expectations were not related to postoperative satisfaction and that males in the study had higher postoperative fulfilment scores.

Dr. Sarungi told OTW, “Despite careful and detailed counselling and discussion as a part of informed consent, patients often have somewhat unrealistic expectations and these unmet expectations may lead to patient dissatisfaction (less than 50% of all expectations were fulfilled).”

“Our study showed that despite detailed counselling, discussion with the help of information booklets prior to knee replacement, there is still a high number of unmet and/or unrealistic expectations related to total knee replacement. More emphasis/focus is needed not only on good patient selection (e.g. bone and bone OA), but also on exploring the patient’s expectations; clearer guidance regarding realistic expectations and better patient education prior to knee replacement surgery are likely to improve the overall satisfaction with the operation.”