Patient Outcome Expectations Of Knee Arthroplasty And The Association With Post-operative Function And Satisfaction

Objectives To translate Hospital for Special Surgery Knee Replacement Expectations Surveys(HSS Knee Replacement Expectations Surveys) into Chinese and amend it according to the cultural background. To investigate the expectations of patients with total knee arthroplasty(TKA) and explore its correlation with postoperative clinical status and patients’ satisfaction, evaluating its clinical significance.Methods From January 2014 to September 2015, 102 patients who scheduled to undergo TKA were investigated. All the patients came from orthopedics department of Tianjin Medical University General Hospital. Our study had two parts. The first part was building Chinese version of HSS Knee Replacement Expectations Surveys. The second part was an investigational study. 2 to 3 days before the operation, we investigated patients’ general data, outcome expectation scores, WOMAC scores and SF-36 scores. Six months later, we called the patients to get their WOMAC scores, SF-36 scores and satisfaction to the operations. In this research, reliability analysis, factor analysis, correlation analysis, t test, multiple stepwise regression analysis, and nonparametric test were performed to analyze the data with SPSS 17.0.Results 1. The reliability and validity of Chinese version of HSS Knee Replacement Expectations Surveys Cronbach’s alpha of the HSS Knee Replacement Expectations Surveys was 0.827, which meant internal consistency of the survey was good. In exploratory factor analysis, KMO value was 0.797 and Bartlett ball test value was 859.273(P<0.01), suggesting the survey was suitable for factor analysis. By principal component analysis, five common factors were got(eigenvalues >1), which explained 69.124% of the total variance. Pearson correlation coefficient of preoperative patient outcome expectations measured by HSS Knee Replacement Expectations Surveys and the expectation WOMAC is 0.790(P<0.01). 2. Outcome expectations of patients scheduled to undergo TKA The average HSS expectation score of TKA patients was(43.07±5.27). After standardization conversion, the average score was(63.34±7.75). The average expectation score to pain relief and walking ability were 3.97, 3.90. The average expectation score to sexual activity and psychological well-being were 1.04, 1.19. 3. The correlation between patient outcome expectation and clinical status, SF-36 postoperatively The average WOMAC score of patients 6 months after TKA operation was(20.86±4.45) and the average SF-36 score was(62.16±6.89). Compared with preoperative WOMAC score and SF-36 score, the difference was statistically significant(P<0.05). Pearson correlation analysis results showed that patient outcome expectation had no correlation with WOMAC score and SF-36 score 6 months after operation. 4. The correlation between patient outcome expectation and postoperative satisfaction 75.8% of patients were satisfied with the operation, and 24.2% of the patients were not satisfied. Patients with different degree of satisfaction, their outcome expectation score, postoperative SF-36 score and postoperative WOMAC score were statistically different(P<0.05). In the logistic regression analysis, patient expectations, postoperative SF-36 score eventually went into the regression equation.Conclusion 1. Chinese version of HSS Knee Replacement Expectations Survey was suitable for Chinese, and the reliability and validity were good. 2. Outcome expectation of knee arthroplasty in our country was higher than their true status, but compared to the foreigner, the expectation score was lower. Patients with the highest expectation to pain relief, the follow-up were walking ability. The expectations to sexual activity and psychological well-being were low. 3. Outcome expectation had no influence on postoperative WOMAC score and postoperative SF-36 score. 4. Outcome expectation could affect postoperative satisfaction.