Patient expectations and health-related quality of life outcomes following total joint replacement

Value Health. 2010 Jun-Jul;13(4):447-54. doi: 10.1111/j.1524-4733.2009.00685.x. Epub 2010 Jan 15.


Objectives: Patient psychological factors have been linked to health-related quality of life (HRQoL) outcomes after total joint replacement (TJR). We evaluated the relationship between patient expectations before TJR, their fulfillment and HRQoL outcomes at 3 and 12 months after surgery.

Methods: Consecutive patients preparing for TJR of the knee or hip due to primary osteoarthritis in 15 hospitals in Spain were recruited for the study. Patients completed questionnaires before surgery, and 3 and 12 months afterward: five questions about expectations before surgery and their fulfillment at 3 and 12 months; three HRQoL instruments-Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form 12 (SF-12), and European Quality of Life Instrument (EQ-5D); as well as questions about sociodemographic information. Student's t test was used to assess the relationship between fulfillment of expectations and gains in HRQoL.

Results: A total of 881 patients took part in the study. Preintervention expectations for TJR ranged from 85% to 86% of patients, with high expectations for pain relief and ability to walk to 70% with high expectations about interacting with others. Patients who reported having fulfilled their expectations at 3 and 12 months had significantly greater gains in HRQoL than those who did not. Besides, we observed a statistically significant improvement in the percentage of patients who fulfill their expectations from 3 to 12 months.

Conclusions: Patients have high expectations for the benefits of TJR, and those who fulfill their expectations have greater gains in HRQoL assessing by SF-12, WOMAC and EQ-5D. Health-care providers should help their patients develop realistic expectations about the impact of TJR.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Adaptation, Psychological
  • Aged
  • Analysis of Variance
  • Arthroplasty, Replacement, Hip* / psychology
  • Arthroplasty, Replacement, Hip* / rehabilitation
  • Arthroplasty, Replacement, Knee* / psychology
  • Arthroplasty, Replacement, Knee* / rehabilitation
  • Attitude to Health*
  • Female
  • Health Status*
  • Humans
  • Male
  • Patient Satisfaction
  • Prospective Studies
  • Quality of Life*
  • Spain