Patients' expectations of knee surgery

Background: Patients' expectations of medical care are linked to their requ ests for treatment and to their assessments of outcome and satisfaction. Ou r goals were to measure patients' preoperative expectations of knee surgery and to develop and test patient-derived knee expectations surveys. Methods: An initial sample of 377 patients (mean age; 54.6 +/- 18.2 years; 52% women) was enrolled in the survey-development phase. One hundred and si xty-one (43%) of these patients subsequently underwent total knee arthropla sty; seventy-five (20%), cruciate ligament repair; eighty-five (23%), menis cal surgery; and fifty-six (15%), surgery for another knee condition. Preop eratively, these patients were asked open-ended questions about their expec tations of knee surgery. Their responses were grouped with use of qualitati ve research techniques to generate categories of expectations. Categories w ere transformed into specific questions and were formatted into two draft s urveys, one for patients undergoing total knee arthroplasty and one for pat ients undergoing other surgical procedures on the knee. A second sample of 163 patients (mean age, 55.1+/-17.5 years; 49% women) was enrolled in the s urvey-testing phase, and they completed the draft surveys on two separate o ccasions to establish test-retest reliability. Items were selected for the final surveys if they were cited by greater than or equal to5% of the patie nts, if they represented important functional changes resulting from surger y, or if they represented potentially unrealistic expectations. All selecte d items fulfilled reliability criteria, defined as a kappa (or weighted kap pa) value of greater than or equal to0.4, or were deemed to be clinically r elevant by a panel of orthopaedic surgeons. Results: From the survey-development phase, a total of fifty-two categories of expectations were discerned; they included both anticipated items such as pain relief and improvement in walking ability and unanticipated items s uch as improving psychological well-being. Expectations varied by diagnosis and patient characteristics, including functional status. Two final survey s were generated: the seventeen-item Hospital for Special Surgery Knee Repl acement Expectations Survey and the twenty-item Hospital for Special Surger y Knee Surgery Expectations Survey. Each required less than five minutes to complete. Conclusions: Patients have multiple expectations of knee surgery in the are as of symptom relief and improvement of physical and psychosocial function, and these expectations vary according to the diagnosis. We developed two v alid and reliable surveys that can be used preoperatively to direct patient education and shared decision-making and to provide a framework for settin g reasonable goals. Reexamining patients' responses postoperatively could p rovide a way to assess fulfillment of expectations, which is a crucial pati ent-derived measure of outcome and satisfaction.