Patient, Doctor Expectations from Joint Replacement Not Aligned

While physicians strive to set realistic expectations for patients undergoing knee and hip joint replacements, a new study reveals that doctor and patient expectations are sometimes not aligned. The study, reported by the Hospital for Special Surgery (HSS) researchers at the American Academy of Orthopedic Surgeons suggests that steps need to be taken to bridge the expectation gap.

This study is among the first to examine discrepancies in patient and physician expectation with joint replacement surgeries, according to Hassan Ghomrawi, PhD, MPH, outcomes research scientist, Biostatistics and Epidemiology, at HSS in New York, who led the study.

The two joint replacement surgeries studied are known as total hip replacement (THR) and total knee replacement (TKR). These procedures are common in individuals older than 50 years old and usually result from normal wear and tear that causes osteoarthritis.

At HSS, patients are required to attend a 90-minute class before surgery where they receive education from a specialized nurse about what they can expect during the surgery and recovery.

“HSS has been giving a preoperative class for many years. This practice is becoming a trend in big hospitals for this type of surgery,” Ghomrawi said in a news release. The results from this study indicate that such classes could be refined and steps can be taken to use these classes to improve patient and physician dialogue.

In a study that compared expectations of 42 patients with their doctors through surveys, investigators found clinically meaningful disagreement in 68% of patients with 53% of the patients’ expectations exceeding the expectations of the surgeons.

“The take home message for the surgeon is that inexpensive, educational interventions like a preoperative class can be used to better align the patient’s and the surgeon’s expectations prior to surgery,” Alejandro Gonzalez Della Valle, MD, associate attending orthopedic surgeon at HSS, who was involved with the study, said. “This may ultimately result in higher perceived outcome.”

The study included patients who were scheduled to receive a hip or knee replacement by a dedicated hip and knee surgeon. Both patient and doctor completed either a THR or TKR recovery expectation questionnaire. The surveys involved various questions with a scale from 1 to 5, ranging from a 1 being “return to normal,” to a 4 being “very little improvement,” and 5 being “I don’t have this expectation.”

The numbers from each of the questions on the survey were then plugged into a formula that calculated a score ranging from 0 to 100, with 100 being the highest expectation. The study involved 25 patients undergoing THR and 17 patients undergoing TKR. Both patients and doctors completed surveys. The average surgeon expectation score was 75 (range 43 to 93) and the average patient expectation score was 84 (range 47 to 100).

“We observed a lot of variability between what the surgeon expected and what the patient expected. In an ideal world, the expectations of the patient and the surgeon should be similar,” Gonzalez Della Valle said.

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