THU0445 ASSOCIATION BETWEEN PATIENT'S EXPECTATION AND SATISFACTION FOLLOWING TOTAL KNEE REPLACEMENT FOR OSTEOARTHRITIS

Abstract

Background: Up to 20% of patients are dissatisfied with the outcome of total knee replacement (TKR). Pre-operative expectations may affect patient's outcomes, including satisfaction after surgery. Better understanding of patient's expectation could aid the development and improvements of pre-operative education. Pre-operative expectations and post-operative satisfaction may vary across cultures and have not been described in an Asian context. Objectives: We aimed to evaluate the association between patient's preoperative expectation and post-operative satisfaction following TKR for osteoarthritis. Methods: Patients listed for TKR because of OA in a tertiary referral centre were recruited. Pre-operatively, participants completed sociodemo-graphic questions, Western Ontario and McMaster Universities Index (WOMAC) pain and function, and the Hospital for Special Surgery (HSS) KR expectation survey. At 6 months after TKR, patients rated their satisfaction with each expectation on the HSS as completely satisfied, partially satisfied or dissatisfied. Overall satisfaction with TKR was assessed with a 4-point Likert scale and dichotomized to satisfied or dissatisfied. Association between overall satisfaction at 6 months and pre-operative expectation was analysed using logistic regression after adjustment for demographic data. Results: Between June 2017 and December 2017, 215 patients were recruited and completed follow up at 6 months after TKR (71% female, 82% Chinese, mean age 65±7 years). The overall satisfaction rate was 92%. The most prevalent pre-operative expectations were improved ability to perform daily activities (85%), participation in recreation (83%), pain relief (81%) and ability to change position (81%) (Figure 1). At 6 month after TKR, the top five fulfilled expectations (defined as 'completely satisfied') were improvement in the ability to perform daily activities (82%), walking short distance (66%), improvement in psychological well-being (64%), pain relief (64%) and position change (56%) (Figure 1). For most items on the questionnaire, expectations were high and not fully met; however most patient's expectations were at least partially met. In the logistic regression model, post-operative HSS total score, but not preoperative HSS score, was associated with overall satisfaction (P<0.01) after adjusting for demographic data (Table 1). (Table Presented) Conclusion: Although most patient's expectations were at least partially met, they were not fully met. This suggests that many patients have unrealistic expectations of TKR outcome. Fulfilment of expectations, rather than expectation per se, was the most important variable associated with patient's overall satisfaction.