Higher Preoperative Patient Activation Associated With Better Patient-reported Outcomes After Total Joint Arthroplasty

Clin Orthop Relat Res. 2015 Aug;473(8):2688-97. doi: 10.1007/s11999-015-4247-4. Epub 2015 Mar 11.


Background: Despite widely reported success associated with hip and knee replacements, some patients remain dissatisfied with their outcomes. Patient activation, an individual's propensity to engage in adaptive health behaviors, has been measured as a potentially important factor contributing to health outcomes, cost, and patient experience of care. However, to our knowledge, it has not been studied in patients undergoing total joint arthroplasties (TJAs).

Questions/purposes: We wanted to determine whether patients with higher activation scores would experience (1) greater resolution of pain and improved activity, (2) greater improvements in postoperative physical and mental health, and (3) greater patient satisfaction after primary THA or TKA.

Methods: We approached 174 patients and enrolled 135 who were undergoing primary THA or TKA at one of two hospitals between January 2013 and May 2014. Patient Activation Measure (PAM) scores were obtained preoperatively and patient-reported outcomes were assessed and completed for 125 patients pre- and postoperatively at the 6- or 12-month visit. We assessed pain and activity with the Hip Disability and Osteoarthritis Outcome Score (HOOS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and University of California Los Angeles (UCLA) activity scores. We measured physical and mental health by calculating SF12v2® scores and measured patient satisfaction with the Hip and Knee Satisfaction Scale (HKSS). Linear regression models were used to test the association between baseline PAM and postoperative patient-reported outcomes.

Results: Overall, patients with a higher baseline PAM score experienced better pain relief using the HOOS/KOOS pain scores (R2=0.311, p=0.048) and symptoms using the HOOS/KOOS symptom scores (R2=0.272, p=0.021). In addition, higher PAM scores were associated with better postoperative mental health using the SF12v2® (R2=0.057, p<0.001), but were not associated with higher physical health (R2=0.176, p=0.173). Finally, higher PAM scores were associated with having greater postoperative satisfaction after surgery using the HKSS questionnaire (R2=0.048, p=0.023).

Conclusions: Higher preoperative patient activation was associated with better pain relief, decreased symptoms, improved mental health, and greater satisfaction after TJA. Future efforts should be aimed at studying if improving patient activation before surgery results in better patient-reported outcomes after elective THA or TKA.

Level of evidence: Level II, prognostic study.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip* / adverse effects
  • Arthroplasty, Replacement, Knee* / adverse effects
  • Disability Evaluation
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Hip Joint / physiopathology
  • Hip Joint / surgery*
  • Humans
  • Knee Joint / physiopathology
  • Knee Joint / surgery*
  • Linear Models
  • Los Angeles
  • Male
  • Mental Health
  • Middle Aged
  • Pain Measurement
  • Pain, Postoperative / etiology
  • Pain, Postoperative / prevention & control
  • Patient Participation*
  • Patient Satisfaction
  • Recovery of Function
  • Risk Factors
  • San Francisco
  • Surveys and Questionnaires
  • Treatment Outcome