Determinants of satisfaction 1 year after total hip arthroplasty: the role of expectations fulfilment

Clémence Palazzo, Claire Jourdan, Stéphane Descamps, Rémi Nizard, Moussa Hamadouche, Philippe Anract, Stéphane Boisgard, Myriam Galvin, Philippe Ravaud, Serge Poiraudeau, Clémence Palazzo, Claire Jourdan, Stéphane Descamps, Rémi Nizard, Moussa Hamadouche, Philippe Anract, Stéphane Boisgard, Myriam Galvin, Philippe Ravaud, Serge Poiraudeau

Abstract

Background: Between 7% and 15% of patients are dissatisfied after total hip arthroplasty (THA). To assess predictors and postoperative determinants of satisfaction and expectation fulfilment one year after (THA).

Methods: Before THA surgery, 132 patients from three tertiary care centres and their surgeons were interviewed to assess their expectations using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (THR survey). One year after surgery, patients (n = 123) were contacted by phone to complete a questionnaire on expectation fulfilment (THR survey), satisfaction, functional outcome (Womac), and health-related quality of life (SF 12). Univariate and multivariate analyses were performed.

Results: Preoperative predictors of satisfaction were a good mental wellbeing (adjusted OR 1.09 [1.02; 1.16], p = 0.01) and optimistic surgeons expectations (1.07 [1.01; 1.14], p = 0.02). The main postoperative determinant of satisfaction was the fulfilment of patient's expectations (1.08 [1.04; 1.12], p < 0.001). Expectation fulfilment could be predicted before surgery by young age (regression coefficient -0.55 [-0.88; -0.21], p = 0.002), good physical function (-0.96 [-1.82; -0.10], p = 0.03) and good mental wellbeing (0.56 [0.14; 0.99], p = 0.01). Postoperative determinants of expectation fulfilment were functional outcome (-2.10 [-2.79; -1.42], p <0.001) and pain relief (-14.83 [-22.38; -7.29], p < 0.001).

Conclusion: To improve patient satisfaction after THA, patients' expectations and their fulfilment need to be carefully addressed. Patients with low mental wellbeing or physical function should be identified and specifically informed on expected surgical outcome. Surgeons' expectations are predictive of satisfaction and information should aim to lower discrepancy between surgeons' and patients' expectations.

Figures

Figure 1
Figure 1
Frequency of patients and surgeons for which expectations were unmet regarding the 18 items of the THR survey (“n = …” corresponds to the number of applicable items).
Figure 2
Figure 2
Predictors and variables associated with satisfaction and expectations fulfilment (it only includes the relationships explored in this study).

References

    1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basanez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D. et al.Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163–96. doi: 10.1016/S0140-6736(12)61729-2.
    1. Pereira D, Peleteiro B, Araujo J, Branco J, Santos RA, Ramos E. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis Cartilage. 2011;19(11):1270–85. doi: 10.1016/j.joca.2011.08.009.
    1. Picavet HS, Hazes JM. Prevalence of self reported musculoskeletal diseases is high. Ann Rheum Dis. 2003;62(7):644–50. doi: 10.1136/ard.62.7.644.
    1. Woolf A, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646–56.
    1. Higashi H, Barendregt JJ. Cost-effectiveness of total hip and knee replacements for the Australian population with osteoarthritis: discrete-event simulation model. PLoS One. 2011;6(9):e25403. doi: 10.1371/journal.pone.0025403.
    1. Ng CY, Ballantyne JA, Brenkel IJ. Quality of life and functional outcome after primary total hip replacement. A five-year follow-up. J Bone Joint Surg (Br) 2007;89(7):868–73.
    1. Nilsdotter AK, Petersson IF, Roos EM, Lohmander LS. Predictors of patient relevant outcome after total hip replacement for osteoarthritis: a prospective study. Ann Rheum Dis. 2003;62(10):923–30. doi: 10.1136/ard.62.10.923.
    1. Jones CA, Beaupre LA, Johnston DW, Suarez-Almazor ME. Total joint arthroplasties: current concepts of patient outcomes after surgery. Rheum Dis Clin North Am. 2007;33(1):71–86. doi: 10.1016/j.rdc.2006.12.008.
    1. Anakwe RE, Jenkins PJ, Moran M. Predicting dissatisfaction after total hip arthroplasty: a study of 850 patients. J Arthroplasty. 2011;26(2):209–13. doi: 10.1016/j.arth.2010.03.013.
    1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–5. doi: 10.2106/JBJS.F.00222.
    1. Mannion AF, Kampfen S, Munzinger U, Kramers-de Quervain I. The role of patient expectations in predicting outcome after total knee arthroplasty. Arthritis Res Ther. 2009;11(5):R139. doi: 10.1186/ar2811.
    1. Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006;452:35–43.
    1. Mancuso CA, Jout J, Salvati EA, Sculco TP. Fulfillment of patients’ expectations for total hip arthroplasty. J Bone Joint Surg Am. 2009;91(9):2073–8. doi: 10.2106/JBJS.H.01802.
    1. Rolfson O, Dahlberg LE, Nilsson JA, Malchau H, Garellick G. Variables determining outcome in total hip replacement surgery. J Bone Joint Surg (Br) 2009;91(2):157–61.
    1. Hossain M, Parfitt DJ, Beard DJ, Darrah C, Nolan J, Murray DW, Andrew G. et al.Does pre-operative psychological distress affect patient satisfaction after primary total hip arthroplasty? BMC Musculoskelet Disord. 2011;12:122. doi: 10.1186/1471-2474-12-122.
    1. Mancuso CA, Salvati EA, Johanson NA, Peterson MG, Charlson ME. Patients’ expectations and satisfaction with total hip arthroplasty. J Arthroplasty. 1997;12(4):387–96. doi: 10.1016/S0883-5403(97)90194-7.
    1. Haanstra TM, van den Berg T, Ostelo RW, Poolman RW, Jansma EP, Cuijpers P, de Vet HC. et al.Systematic review: do patient expectations influence treatment outcomes in total knee and total hip arthroplasty? Health Qual Life Outcomes. 2012;10:152. doi: 10.1186/1477-7525-10-152.
    1. Mahomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Fossel AH, Katz JN. et al.The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol. 2002;29(6):1273–9.
    1. Gandhi R, Davey JR, Mahomed N. Patient expectations predict greater pain relief with joint arthroplasty. J Arthroplasty. 2009;24(5):716–21. doi: 10.1016/j.arth.2008.05.016.
    1. Marcinkowski K, Wong VG, Dignam D. Getting back to the future: a grounded theory study of the patient perspective of total knee joint arthroplasty. Orthop Nurs. 2005;24(3):202–9.
    1. Carr-Hill RA. The measurement of patient satisfaction. J Public Health Med. 1992;14(3):236–49.
    1. Scott CE, Bugler KE, Clement ND, Macdonald D, Howie CR, Biant LC. Patient expectations of arthroplasty of the hip and knee. J Bone Joint Surg (Br) 2012;94(7):974–81.
    1. Jourdan C, Poiraudeau S, Descamps S, Nizard R, Hamadouche M, Anract P, Boisgard S, Galvin M, Ravaud P. et al.Comparison of patient and surgeon expectations of total hip arthroplasty. PLoS One. 2012;7(1):e30195. doi: 10.1371/journal.pone.0030195.
    1. Mancuso CA, Sculco TP, Salvati EA. Patients with poor preoperative functional status have high expectations of total hip arthroplasty. J Arthroplasty. 2003;18(7):872–8. doi: 10.1016/S0883-5403(03)00276-6.
    1. Mancuso CA, Graziano S, Briskie LM, Peterson MG, Pellicci PM, Salvati EA, Sculco TP. et al.Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties. Clin Orthop Relat Res. 2008;466(2):424–31. doi: 10.1007/s11999-007-0052-z.
    1. Beaton D, Bombardier C, Guillemin F, Ferraz M. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25:3186–91. doi: 10.1097/00007632-200012150-00014.
    1. Andrews F, Withey S. Social indicators of well-being: American’s perceptions of life quality. New York: Plenum Press; 1976.
    1. Tubach F, Baron G, Falissard B, Logeart I, Dougados M, Bellamy N, Ravaud P. et al.Using patients’ and rheumatologists’ opinions to specify a short form of the WOMAC function subscale. Ann Rheum Dis. 2005;64(1):75–9. doi: 10.1136/ard.2003.019539.
    1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–40.
    1. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33. doi: 10.1097/00005650-199603000-00003.
    1. Kiebzak GM, Campbell M, Mauerhan DR. The SF-36 general health status survey documents the burden of osteoarthritis and the benefits of total joint arthroplasty: but why should we use it? Am J Manag Care. 2002;8(5):463–74.
    1. Barton K. Package “MuMin”. Version 1.9.18. Available on: (date: 2014/02/06)
    1. Vissers MM, Bussmann JB, Verhaar JA, Busschbach JJ, Bierma-Zeinstra SM, Reijman M. Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review. Semin Arthritis Rheum. 2012;41(4):576–88. doi: 10.1016/j.semarthrit.2011.07.003.
    1. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. doi: 10.1016/S0140-6736(12)60240-2.
    1. Holtzman J, Saleh K, Kane R. Effect of baseline functional status and pain on outcomes of total hip arthroplasty. J Bone Joint Surg Am. 2002;84-A(11):1942–8.
    1. MacWilliam CH, Yood MU, Verner JJ, McCarthy BD, Ward RE. Patient-related risk factors that predict poor outcome after total hip replacement. Health Serv Res. 1996;31(5):623–38.
    1. Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, Phillips C, Partridge AJ, Bélisle P, Fossel AH, Mahomed N, Sledge CB, Katz JN. et al.Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum. 1999;42(8):1722–28. doi: 10.1002/1529-0131(199908)42:8<1722::AID-ANR22>;2-R.
    1. Harris IA, Harris AM, Naylor JM, Adie S, Mittal R, Dao AT. Discordance between patient and surgeon satisfaction after total joint arthroplasty. J Arthroplasty. 2013;28(5):722–7. doi: 10.1016/j.arth.2012.07.044.
    1. Hawker GA. Who, when, and why total joint replacement surgery? The patient’s perspective. Curr Opin Rheumatol. 2006;18(5):526–30.
    1. Peduzzi P, Concato J, Feinstein AR, Holford TR. Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates. J Clin Epidemiol. 1995;48(12):1503–10. doi: 10.1016/0895-4356(95)00048-8.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren