Knee arthroplasty: are patients' expectations fulfilled? A prospective study of pain and function in 102 patients with 5-year follow-up

Abstract

Background and purpose: With an aging population expecting an active life after retirement, patients' expectations of improvement after surgery are also increasing. We analyzed the relationship between preoperative expectations and postoperative satisfaction and self-reported outcomes with regard to pain and physical function after knee arthroplasty.

Patients and methods: 102 patients (39 men) with knee osteoarthritis and who were assigned for TKR (mean age 71 (51-86) years) were investigated with KOOS, SF-36, and additional questions concerning physical activity level, expectations, satisfaction, and relevance of the outcome to the patient. These investigations took place preoperatively and postoperatively after 6 months, 1 year, and 5 years of follow-up.

Results: Response rate at 5 years was 86%. In general, the patients' preoperative expectations were higher than their postoperative ability. For example, 41% expected to be able to perform activities such as golfing and dancing while only 14% were capable of these activities at 5 years. Having high or low preoperative expectations with regard to walking ability or leisure-time activities had no influence on the KOOS scores postoperatively. 93% of the patients were generally satisfied 5 years postoperatively, while 87% were satisfied with the relief of pain and 80% with their improvement in physical function at that time.

Interpretation: With an expanding population of mentally alert elderly, we can expect that great demands will be put on joint replacements. This study shows that patients have high preoperative expectations concerning reduction of pain. To a considerable extent, these expectations are fulfilled after one year. Expectations concerning demanding physical activities are not fulfilled to the same degree; however, most patients reported general satisfaction with the outcome indicating that satisfaction is not equivalent to fulfilled expectations. Preoperative counseling should include realistic information on outcomes concerning physical function and pain relief.

Figure 1.

Breakdown of patients’ (n = 80) expectations preoperatively, the situation preoperatively, and outcome concerning walking ability. Crutches: the need for crutches or some other device to move more than a few steps; indoors: able to walk indoors; < 1 km: able to walk indoors and less than 1 km outdoors; > 1 km: able to walk more than 1 km; unlimited: unlimited walking on even ground; uneven terrain: unlimited walking on uneven terrain.

Figure 2.

Breakdown of patients’ (n = 80) expectations preoperatively, the situation preoperatively, and outcome concerning leisure activities. No: no household work, only TV and reading; minimal: minimal household work, card games, and sewing; light: light yard work, light household work, shopping; heavy: heavy yard work, heavy household work; golf, dance: golf, dancing, hiking, water aerobics; recr sports: recreational sports.

Figure 3.

Percentages of patients (n = 80) with high expectations (much less or less pain; better or much better ADL, better or much better sport/recr) preoperatively and the percentages of patients reporting fulfilled expectations at 3 different follow-up times. ADL: activities of daily living; sport/recr: sport and recreational function; exp: expectations.

Figure 4.

Percentage of patients who reported satisfaction (extremely satisfied, very satisfied) at the follow-ups 6 months, 12 months, and 5 years after TKR. The first (left-hand) block shows general satisfaction and the others show specific satisfaction in relation to the 5 KOOS subscales.