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Introduction

Introduction. Higher expectations , better outcomes Unrealistic expectations , dissatisfaction Information can influence expectations. Objective. Examine the effect of patient attributes on expectations before TKA. Materials and Methods. Prospective study Exclusion criteria

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Introduction

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  1. Introduction • Higherexpectations, betteroutcomes • Unrealisticexpectations, dissatisfaction • Information can influenceexpectations

  2. Objective Examine theeffect of patientattributesonexpectationsbefore TKA

  3. Materials and Methods • Prospectivestudy • Exclusioncriteria • Refusalorinabilityto complete study • 1943 patients (1st may 2008/30th april 2009) • Variables • Kneeexpectationssurvey, VAS, SF-36, KOOS, LEAS • Demographicparameters • Questionnaires 2 weeksbeforesurgery

  4. Statistics • SAS software package • Pearsoncorrelationcoefficients (r) • r>0,6 strongcorrelation • 0,3<r<0,6 moderatecorrelation • 0,1<r<0,3 weakcorrelation

  5. Results • 3035 patientsoperated in thatperiod • 1943 studypopulation • Mean age 67 +/-10 years • 51% over 80 in KES (Highexpectations) • Younger, male and whitepatientshadsignificantlyhigherexpectations (p<0.05) • No relationshipwithlevel of education

  6. Results • Living with a partner, higherexpectations • Higherexpectations of returntosexual function? • Thedifferenceremainedwhenquestionwas removed • Healthierpatients, higherexpectations • Higherquality of life, higherexpectations • More active patients, higherexpectations • History of TJA, lowerexpectations

  7. Discussion • Patientsatisfactionmaybedependentonmanagingexpectations • Patientswithlowexpectations, lesslikelytoelectsurgery • Statisticallysignificanteffect of race, whenmultivariateanalysisthediferencedisappeared (confounding factor) • Live alone, lowerexpectations, no familysupport

  8. Discussion • No influence of pre-opkneepainorfunction • No modulation of theirexpectationsbasedon pre-op status of theknee • Patientshigherexpectationsthantheirsurgeons • Experience leads to more accurateexpectations • Identifying and addressingunrealisticexpectations, more satisfaction

  9. Discussion • Correlationsobservedweresmall • Theydon’texplaintheobservedvariability • Otherfactors (influencingtheexpectations): • Largesamplesize (eliminatesignificant variables of smallstudies) • Psychologicalprofile • Lifeexpiriencewithsurgery • Perceptionbyfriendsorfamily

  10. Conclusion • Highpotentiallyunrealisticexpectations are common and notconfinedtoyoungor active patients, highlightingtheneedfordiscussion of realisticexpectationswithallpatients

  11. Limitations • Using a validated mesure, but • Subjectiveexpectationsurvey (frame-of-reference) • 50 yearsoldpatientwhoclimbed Everest • 75 yearsoldpatientwhoexpects a full returntobowling • Future mesures shouldbe more especific • Specific center withspecificpopulation

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