Correlation Between Expectations And Fulfillment Of Expectations With Clinical Outcomes And Satisfaction In TKA Patients

Objective:Osteoarthritis is an articular cartilage degenerative disease which could cause symptoms such as joint pain,deformity and mobility disorders.Knee osteoarthritis accounts for more than 80% of the osteoarthritis diseases.Total knee arthroplasty(TKA)is considered to be the only effective treatment for end-stage knee osteoarthritis,which can effectively relieve patients’ pain and joint function and improve the quality of life of patients.Patient’s expectations are described as the patient’s desire for a particular event to occur during medical procedures or outcomes.Positive expectations are considered to have a "placebo" effect,which can significantly improve the patient’s symptoms of pain and anxiety,while negative expectations are considered to have an "anti-placebo" effect,which means that the patient will have a worse clinical outcome.Most studies on the expectations of TKA patients are based on European and American populations,but the expectations in different populations may be quite different.Few people have investigated the expectations of TKA patients in Asian populations,especially in China.Different studies` results about the impact of expectations on TKA patients’ clinical outcomes and satisfaction are also contradictory,some studies believe that higher preoperative expectations predict better clinical outcomes or higher satisfaction after surgery,but others have refuted this view.In recent years,more and more medical scholars begin to pay attention to the fulfillment of patient`s expectations,but there is less research on its role in TKA patients.In addition,influencing factors in TKA patients’ expectations and fulfillment of expectations have not been identified either.In summary,the purpose of this study was: 1.Evaluating the preoperative expectations and postoperative fulfillment of expectations in Northern China TKA patients;2.Explore the relationship between preoperative expectations and postoperative fulfillment of expectations with the patient-reported clinical outcomes and satisfaction;3.Explore the factors that could influence expectations and fulfillment of expectations.Methods:This study initially included 174 patients who underwent unilateral primary total knee arthroplasty in Tianjin Hospital joint surgical center during 2018.08-2019.02.Demographic data,historic diseases,and the Hospital for Special Surgery Knee Replacement Expectations Survey(HSS-KRES),WOMAC scale,The Short Form 36(SF-36)were collected from patients within 3 days before the operation.One year after the operation,we asked patients to complete the survey of expectations fulfillment which based on the HSS-KRES scale,the survey of patient`s satisfaction for operation,and collected the patient’s WOMAC scale and The Short Form 36(SF-36)again.With some patients were withdrawn,138 patients were finally included in our study in the end.Results:The average expectations score of Northern China TKA patients before surgery was 45.36 ± 10.81,which converted into the standard percentage score was 66.71 ± 15.89.Improving walking ability and pain relief were considered by patients as the two most important expectations,with the average score exceeding 3.50 points.The overall percentage of patients` expectations fulfillment in Northern China TKA patients after surgery was 73.6%.In a single analysis of expectations,almost all patients’ expectations for pain relief and improvement in walking ability were fulfilled,with the fulfillment percentages was 94.7% and 94.8%.The clinical outcome scores reported by patients were significantly improved after surgery compared with those before surgery.Patients with high preoperative expectation score could more easily achieve the minimum clinically significant changes in WOMAC function scores and SF-36 physiological health scores after surgery;higher expectations fulfillment percentage predict patients could more easily achieve the smallest clinically significant changes in WOMAC pain score,WOMAC function score,SF-36 physical function score,and SF-36 psychological function score after surgery.When the preoperative expectation value was greater than 66.91 points,the minimum clinically significant change in the patient’s reported clinical outcome after the operation could be predicted;the patient’s expectations fulfillment percentage exceeded 70.71% could predict patients getting Minimum clinically significant change in the patient’s reported clinical outcome.The overall satisfaction of TKA patients in 1 year after operation was 84.6%.When the preoperative expectation score was greater than 52.21 points,it could predict that the patients could achieve satisfaction after surgery;when the patient’s expectations fulfillment percentage was greater than 61.2%,it could predict that the patient could achieve satisfaction after surgery.Multivariate analysis showed that only preoperative SF-36 psychological function scores could affect patient expectations;only preoperative WOMAC pain scores and postoperative WOMAC functional scores could affect patient expectations.Conclusion:Northern China TKA patients have high expectations before operation,and high percentage fulfillment of expectations;high expectations score and high expectations fulfillment percentage are positively correlated with the improvement of patients’ postoperative clinical outcomes and satisfaction;some clinical outcomes reported by patients could affect expectations and fulfillment of expectations.