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The Journal of Bone and Joint Surgery (American) 83:1005-1012 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Patients’ Expectations of Knee Surgery

Carol A. Mancuso, MD, Thomas P. Sculco, MD, Thomas L. Wickiewicz, MD, Edward C. Jones, MD, Laura Robbins, DSW, Russell F. Warren, MD and Pamela Williams-Russo, MD, MPH

Investigation performed at the Outcomes Unit, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
Carol A. Mancuso, MD
Thomas P. Sculco, MD
Thomas L. Wickiewicz, MD
Edward C. Jones, MD
Laura Robbins, DSW
Russell F. Warren, MD
Pamela Williams-Russo, MD, MPH
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study. This study was conducted while C.A. Mancuso was a Robert Wood Johnson Generalist Physician Faculty Scholar.

Read at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Orlando, Florida, March 16, 2000.
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our CD-ROM (call 781-449-9780, ext. 140, to order).

Background: Patients’ expectations of medical care are linked to their requests for treatment and to their assessments of outcome and satisfaction. Our 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 sixty-one (43%) of these patients subsequently underwent total knee arthroplasty; seventy-five (20%), cruciate ligament repair; eighty-five (23%), meniscal surgery; and fifty-six (15%), surgery for another knee condition. Preoperatively, these patients were asked open-ended questions about their expectations of knee surgery. Their responses were grouped with use of qualitative research techniques to generate categories of expectations. Categories were transformed into specific questions and were formatted into two draft surveys, one for patients undergoing total knee arthroplasty and one for patients 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 survey-testing phase, and they completed the draft surveys on two separate occasions to establish test-retest reliability. Items were selected for the final surveys if they were cited by 5% of the patients, if they represented important functional changes resulting from surgery, or if they represented potentially unrealistic expectations. All selected items fulfilled reliability criteria, defined as a kappa (or weighted kappa) value of 0.4, or were deemed to be clinically relevant 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 such as improving psychological well-being. Expectations varied by diagnosis and patient characteristics, including functional status. Two final surveys were generated: the seventeen-item Hospital for Special Surgery Knee Replacement Expectations Survey and the twenty-item Hospital for Special Surgery Knee Surgery Expectations Survey. Each required less than five minutes to complete.

Conclusions: Patients have multiple expectations of knee surgery in the areas of symptom relief and improvement of physical and psychosocial function, and these expectations vary according to the diagnosis. We developed two valid and reliable surveys that can be used preoperatively to direct patient education and shared decision-making and to provide a framework for setting reasonable goals. Reexamining patients’ responses postoperatively could provide a way to assess fulfillment of expectations, which is a crucial patient-derived measure of outcome and satisfaction.


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