Comparison of patient and surgeon expectations for total hip arthroplasty

Abstract

Purpose: Expectations of patients concerning total hip arthroplasty (THA) are related to willingness to undergo surgery and to later satisfaction. Analysis of discrepancies between patient and surgeon expectations before THA should lead to better understand motives of dissatisfaction about surgery, but this question has been seldom studied. Our objectives were to compare surgeons' and patients' expectations before THA, using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (THR Survey) and to study factors which affect surgeon-patient agreement. Methods: Adult patients on waiting list for THA in three tertiary care centres were interviewed by phone, to assess their expectations and clinic-demographic characteristics. Surgeons used the same questionnaire to assess their expectations regarding the surgery of each patient. Patients' and surgeons' answers on THS questionnaire were compared, and differences between surgeons and patients scores were obtained. Univariate and multivariate analyses were used to test the effect of patients' characteristics on surgeon-patient differences. Results: The three centres recruited 19 surgeons and 132 patients. Mean age was 62.8+/-13.7 years, 52% of patients were men. Indication for surgery was osteoarthritis in 82%, avascular necrosis in 12%. Surgeons' and patients' expectations scores were respectively 90.9+/-11.1 and 90.0+/-11.6 over 100. Mean surgeon-patient difference was close to zero, but surgeons' and patients' expectations scores showed little agreement on Bland and Altman graph and intraclass correlation coefficient was low (0.16). Patients expected better results than surgeons concerning exercise and sports. Patients with worse disability or physical quality of life, and patients with higher scores on trust in physician were likely to expect more than their surgeons and vice versa. Patients who were workers or employees were mostly more enthusiastic while patients who had a liberal, senior officer or intermediate occupation were mostly less enthusiastic. Patients with at least one comorbidity were mostly more enthusiastic, while patients with no comorbidity had mostly similar expectations than their surgeons. Conclusions: Surgeons and patients do not agree on what to expect from THA, although there is no systematic bias between them. Patients with higher disability may have unrealistically high expectations.