How Do Patients’ Preop Expectations Affect Postop Satisfaction with TJA?

    A recently published study from Belgium examines the issue of why patients are dissatisfied after total joint replacement surgery despite a clinically good outcome.

    A “good” outcome of a total hip or total knee arthroplasty can be objectively evaluated based on clinical parameters. But is it truly a good outcome if the patient’s subjective level of satisfaction does not match the clinical assessment?

    Orthopaedic surgeons continue to wrestle with this issue of patient dissatisfaction in the face of a demonstrably positive outcome. Why does the mismatch persist, particularly with total knee arthroplasty patients?

    An interesting study from Belgium, published online December 15 by PLoS ONE, looks at the issue from the perspective of patient expectations, examining the relationship between expectations before surgery and patient-reported outcomes 1 year after the procedure.

    The abstract of the study is republished below. The full article can be accessed here.



    The objective of this study was to assess the number and magnitude of preoperative expectations and to correlate them with the degree of satisfaction expressed one year after Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA), in patients with severe and painful osteoarthritis (OA).

    Materials and Methods

    Preoperative expectations (within 20 days prior to surgery) and postoperative satisfaction (one year after the intervention) were measured using the previously validated French version of the Hospital for Special Surgery Hip or Knee Replacement Expectations Survey. Postoperative satisfaction was measured using a specific scale, following the same methodology as that used for the assessment of expectations. Prediction of the satisfaction of the patients was performed using multivariate linear regression modelling.


    A total of 138 patients (80 THA and 58 TKA) completed the two parts of the study. The expectations score (mean ± SD) (range 0–100) was 72.58 ± 12.63 before THA and 69.10 ± 13.72 before TKA (p = 0.13). The number of expectations expressed was 14.34 ± 1.32 (out of a potential maximum of 18) before THA and 14.70 ± 2.29 (out of a potential maximum of 19) before TKA. After 1 year, THA generated a significantly higher degree of satisfaction compared to TKA (69.70 ± 14.46 v 60.44 ± 17.54, p<0.001) (range 0–100). The pre-operative expectations score was the single best positive predictor of the post-surgery satisfaction assessment both for TKA and THA.


    Patients undergoing total joint arthroplasty for end-stage OA have a high level of expectations, before both THA and TKA. While both types of interventions significantly improve essential and non-essential activities, the rate of satisfaction is significantly greater post THA. Preoperative expectations are a major contributor to the final degree of satisfaction, one year after surgery. These results re-emphasize the need for an optimal preoperative interaction between health care providers and patients, to allow patients a chance to foresee a reasonable outcome after TJA.


    Neuprez A, Delcour J-P, Fatemi F, et al. Patients’ expectations impact their satisfaction following total hip or knee arthroplasty. PLoS ONE 11(12): e0167911. doi:10.1371/journal.pone.0167911.