Sunday, April 10, 2011

Satisfaction With Outcome After Hip and Knee Replacement Surgery: "It's Not the Keds"

Think back to your youth when you dreamed of being the fastest runner, the basketball player who could magically became airborne as if tiny springs propelled him higher into the air, or the quarterback who was so agile that he could zigzag around countless enemy linemen attempting to thwart his journey to the end zone.  If you were like so many of us, you enthusiastically badgered your parents until they succumbed to your request for the canvas-top sneakers known simply as “Keds.”  Your expectation was that these magical sneakers would make your athletic prowess soar to legendary heights and transition you into a star athlete.  Sometimes athletic dreams were achieved, but more often than not sports abilities remained unchanged post Keds acquisition.  The reason for this is quite simple.  One’s athletic talents, abilities and motivations are intrinsic to each individual, and are often completely independent from influences outside of one ’s self, i.e. “the Keds.”  The ability of an athlete to achieve amazing feats is internally driven.  Similarly, patient outcomes and the satisfaction associated with how well a patient does after hip and knee replacement surgery is most closely aligned with his/her personal motivations and goals.

Patient satisfaction with the outcome of a hip or knee replacement is very high, with only a small number of patients relating dissatisfaction with the results after the procedure.  Several studies have explored this topic and the findings are quite interesting.  Of even greater interest is the correlation between postoperative patient satisfaction and surgeon satisfaction with procedure outcomes.

Patients and surgeons most likely evaluate surgical outcomes from different perspectives. From the patient perspective, satisfaction results when there is an improvement in pain, lessened joint stiffness, improved physical function, and most importantly, an ability to return to the desired lifestyle and level of activity.  These are all subjective findings.  From the surgeon’s perspective, satisfaction is measured by more objective outcomes such as the absence of complications, radiographic (x-ray) verification of appropriate prosthesis placement and alignment, and a low revision rate.  Although it is true that patients and surgeons have divergent but overlapping criteria of success after joint replacement, commonality does exist in the most important elements.  Return to a desired level of function, reduced pain, and increased mobility are shared endpoints for both patients and their surgeons.

Patients and surgeons might have differing opinions of success after total joint replacement surgery.  
When measuring the success of hip and knee replacement surgery, it is important to recognize these differences.  In addition, patient satisfaction is also most likely influenced by patient expectations (and fulfillment of those expectations) and demographic characteristics such as age and education, gender, and ethnicity.  The expectation of complete pain relief after surgery, as well as the expectation of a low risk of complications, has been found to be the best predictors of improved functional outcomes and overall satisfaction following joint replacement surgery.

Patient expectations may be the single most predictor of patient satisfaction.  When considering hip or knee replacement surgery, keep in mind that patients and surgeons might not share the same definition of success and satisfaction.  It is essential that you discuss your expectations with your surgeon prior to the procedure so that you can ensure that your goals are realistic and attainable after joint replacement surgery.  Expectations are a key to appreciated success.  

So, remember when considering hip or knee replacement surgery, it’s not the Keds that will determine how well you do, it is you.

Noble, P., Conditt, M., Cook K., & Mathis, K.  The John Insall Award:  Patient Expectations Affect
Satisfaction with Total Knee Arthroplasty.  Clinical Orthopaedics & Related Research 2006; 452:35-43.

Brokelman, R. B., Van Loon, D. J., & Rijnberg, W. J.  Patient versus surgeon satisfaction after
           total hip arthroplasty.  The Journal of Bone and Joint Surgery 2003; 85-B; 495-498.

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