Evaluating Patients' Expectations From a Novel Patient-Centered Perspective Predicts Knee Arthroplasty Outcome

Stephanie R Filbay; Andrew Judge; Antonella Delmestri; Nigel K Arden; COASt Study Group

doi:10.1016/j.arth.2018.02.026

Evaluating Patients' Expectations From a Novel Patient-Centered Perspective Predicts Knee Arthroplasty Outcome

J Arthroplasty. 2018 Jul;33(7):2146-2152.e4. doi: 10.1016/j.arth.2018.02.026. Epub 2018 Feb 15.

Authors

Stephanie R Filbay¹, Andrew Judge², Antonella Delmestri³, Nigel K Arden¹; COASt Study Group

Collaborators

COASt Study Group:
D Altman, D Beard, A Carr, C Cooper, D Culliford, T Griffin, K Javaid, J Latham, D Murray, R Pinedo-Villanueva, A Price, D Prieto-Alhambra

Affiliations

¹ Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford UK.
² Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, Bristol, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
³ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford UK.

Abstract

Background: One-in-five patients are dissatisfied following knee arthroplasty and <50% have fulfilled expectations. The relationship between knee-arthroplasty expectations and surgical outcome remains unclear.

Purpose: Are expectations regarding the impact of pain on postoperative life predictive of one-year outcome? Does the impact of pain on preoperative quality of life (QOL) influence this relationship?

Methods: Longitudinal cohort of 1044 uni-compartmental (43%) or total knee-arthroplasty (57%) (UKA or TKA) patients, aged mean 69 ± 9 years. Preoperatively, patients reported the impact of pain on QOL and expected impact of pain on life one-year post-arthroplasty. One-year postoperative outcomes: non-return to desired activity, surgical dissatisfaction, not achieving Oxford Knee Score minimal important change (OKS <MIC). Logistic regression including covariates was performed for all patients and subgroups (better vs worse pre-operative pain-related QOL; UKA vs TKA).

Results: Expecting moderate-to-extreme pain (vs no pain) predicted non-return to activity (odds ratio [95% confidence interval], 2.3 [1.3, 4.1]), dissatisfaction (4.0 [1.7, 9.3]), OKS <MIC (3.1 [1.5, 6.3]). Expecting mild pain (vs no pain) predicted worse outcomes for patients with better preoperative pain-related QOL (non-return to activity: 2.7 [1.5, 4.8], OKS <MIC: 2.5 [1.1, 5.5]). Expecting moderate-to-extreme pain (vs. no pain) predicted worse outcomes for patients with worse preoperative pain-related QOL (non-return to activity: 2.4 [1.1, 5.5], dissatisfaction: 5.0 [1.7, 14.8], OKS <MIC: 3.4 [1.4, 8.6]). The odds of a poor outcome in people with worse expectations was higher for UKA patients.

Conclusions: Expecting a worse outcome predicted surgical dissatisfaction, less clinical improvement and non-return to desired activity. Patients expecting a more optimistic outcome relative to preoperative status achieved better surgical outcomes.

Keywords: optimism; pain; patient-reported outcomes; quality of life; satisfaction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Arthroplasty, Replacement, Knee / adverse effects*
Arthroplasty, Replacement, Knee / psychology*
Female
Humans
Logistic Models
Longitudinal Studies
Male
Middle Aged
Motivation
Optimism*
Osteoarthritis, Knee / psychology*
Osteoarthritis, Knee / surgery*
Pain / surgery
Pain Measurement
Patient Participation
Patient Satisfaction*
Patient-Centered Care*
Patients
Postoperative Period
Quality of Life*
Risk
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding