C. Allyson Jones, PT, PhD, and Maria E. Suarez-Almazor, MD, PhD
From the Department of Physical Therapy, University of Alberta, Edmonton AB (Dr. Jones) and UT MD Anderson Cancer Center, Houston, TX (Dr. Suarez-Almazor).
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• Objective: To discuss patient expectations of total knee arthroplasty (TKA), instruments used to measure expectations, and the association between expectations, health outcomes, and satisfaction.
• Methods: Review of the literature.
• Results: TKA is an elective surgery for patients with persistent pain and disability caused by knee arthritis. Expectations regarding the surgical procedure and recovery can vary by diagnosis, personal characteristics, functional status, employment status, and trust in physicians. Patients have high overall expectations for recovery, particularly for pain relief and walking. Surgeons’ expectations tend to be more optimistic than patients’, although a subset of patients may have unrealistically high expectations. Although total joint replacement is an effective treatment for advanced arthritis, approximately 30% of potential candidates are unwilling to proceed with surgery. Potential surgical candidates unwilling to proceed with surgery tend to be older, female, and from ethnic minority groups. Several patient-related factors are associated with satisfaction with TKA, including primary diagnosis, preoperative pain and function, and mental health, including depression, but the relationships of satisfaction with gender, age, and comorbid conditions are less certain.
• Conclusion: A better understanding of patient expectations of TKA and recovery can identify knowledge gaps, misconceptions, and communication barriers, and ultimately improve shared decision making. A core set of reliable and valid instruments to measure expectations may encourage their routine use in both clinical and research settings.
Key words: total knee arthroplasty; osteoarthritis; patient expectations; shared decision making; joint replacement.
Total knee arthroplasty (TKA) is an elective surgery for patients with persistent pain and disability caused by knee arthritis. It is viewed as an effective and cost-effective surgical treatment for end-stage osteoarthritis (OA) [1–4]. As the population ages and obesity rates steadily increase, so will the utilization rates for TKA, with projected demand in the United States expected to grow 673% by 2030 [5–7]. The key indicators for receiving primary TKA are end-stage OA and joint pain . Although TKA is a surgical option when conservative management is exhausted, no consensus exists as to the severity of symptoms required to consider surgery . Variation in the utilization of TKA exists with respect to gender, racial/ethnicity, hospital, and geography [10,11]. These differences cannot be explained by prevalence of arthritis or symptoms or by access to health care alone. Increasingly, studies have shown these variations are largely attributable to patients’ preferences, driven by their beliefs, concerns, familiarity with the procedure, and expectations, along with physician opinion . While physician opinions and recommendations clearly influence patients’ decisions, they do so primarily by modulating patients’ beliefs and expectations.
Patient expectations, not only of the effectiveness of the procedure itself but also of the recovery process, influence the decision to undergo an elective surgery such as joint arthroplasty. Ideally, these expectations should be informed by evidence, but often, lack of knowledge, preconceived beliefs, and misconceptions can taint informed decision making. A better understanding of patient expectations of TKA and recovery can identify knowledge gaps, misconceptions, and communication barriers, and ultimately improve shared decision making. Understanding patient expectations and factors that influence expectations provides a fuller appreciation of the outcomes that are meaningful to patients and can guide preoperative education and open dialogue with patients within a shared decision making model of care. In this paper, we discuss patient expectations of TKA, including expectations regarding outcomes and recovery, fulfillment of expectations, and the association of fulfilled expectations with satisfaction.
Measurement of Expectations
The construct of expectation is complex and situational. The ambiguity within the literature occurs most likely because expectations are multifaceted. Expectation involves the notion of expectancy, with respect to health care, that given events are likely to occur as a result of a medical procedure or treatment. This concept is in contrast to wants, which reflects a patient’s desire or wishes that an event will occur . The term patient expectation, however, is commonly confused with patient preference or value. Preference implies a relative valuation or comparison by the patient and, unlike expectation, may not be explicitly expressed by the patient . Different types of health care expectations exist that broadly relate to what patients expect regarding health care structure, process, and outcome .
Studies of patient expectations are diverse within the orthopedic research field and reflect differing theoretical underpinnings and lack of standardization. The lack of standardization makes measuring the complex concept of expectations challenging. While a number of conceptual models exist, Bowling and colleagues aptly recognize the multidimensionality of expectations and that no one conceptual model captures patient expectations . The lack of standardization was noted in a systematic review by Haanstra and colleagues who found great variety in the definitions and measurements of expectations in studies examining their relationship with outcomes of total joint arthroplasty .
No gold standard measure exists for measuring patient expectations of orthopedic surgery. Zywiel’s systematic review  of 66 studies identified 7 validated instruments for measuring patient expectations for orthopedic surgery: of these, 2 were specific to TKA (Hospital for Special Surgery (HSS) Expectation Survey  and Expectation Domain of the New Knee Scoring System [18,19]), and 2 were generic to musculoskeletal conditions (Expectation domain of the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) Instruments  and the Sunnybrook Surgery Expectation Survey ). A number of other measures used within the literature were identified; however, the psychometric properties for many of these measures were not reported and any evidence of testing and validation were lacking . Some studies used a single question to measure expectations. As patient expectation is multi-dimensional, using a single item to evaluate expectations is problematic. Zywiel and others have called for a core set of reliable and valid instruments to measure expectations [14,22], which may encourage their routine use in both clinical and research settings.
Patients Expectations for TKA Recovery
Although patient concerns vary in terms of importance and severity , pain and physical limitations are primary concerns for patients seeking TKA. Patients have high overall expectations for recovery, particularly for pain relief and walking [24–32]. TKA is an elective surgical procedure that provides substantial pain relief and improvements in function and quality of life, with the largest gains seen within the first 6 months [33,34]. Both short-term and long-term effect sizes for pain relief and functional recovery are large, in excess of 1.0 . Over 70% of patients undergoing TKA expect to be pain-free, and 35% expect to have no limitations with routine activities [24,28,31].
Expectations regarding the surgical procedure and recovery can vary by diagnosis, personal characteristics, functional status , employment status, and trust in physicians [32,35]. There is, however, inconsistent evidence on associative preoperative factors of recovery expectations. While some evidence supports an association between higher expectations and younger age and greater preoperative functional limitation [26–28,32,36–38], others have reported no significant association with several preoperative factors including age, gender, and preoperative functional status [24,26,37]. Lower overall expectations  and lower expectations for pain relief  were also seen for patients with a greater number of comorbid conditions.
It may be that patients with high preoperative expectations are more optimistic, interpret their health-reported quality of life gains more liberally, and are more likely to adhere to rehabilitation treatment [24,25]. Optimism is a generalized expectancy of a positive outcome that is related to indicators of well-being . Presurgical optimism was shown to be associated with less postsurgical pain and anxiety in patients undergoing total hip and knee arthroplasty .
In addition to general future-oriented constructs, such as optimism, treatment-specific psychological constructs, such as treatment credibility and treatment expectancy, are seen in patients with total joint arthroplasty. A strong but not redundant association is seen between treatment expectancy and treatment credibility, that is, expectations of a treatment may be related as to how credible the treatment outcomes appear [41,42]. Haanstra and colleagues advocate further clinical work to explore which factor predicts total joint arthroplasty outcomes so that patients who are at a higher risk of poor outcomes can be identified .
Others have recognized that perspectives and expectations of surgical outcomes differ between patient and surgeon [43–45]. Overall, surgeons’ expectations tend to be more optimistic than patients expectations of outcomes, although a subset of patients may have unrealistically high expectations . Patients do not always realize that some of their expectations cannot be met by current orthopedic procedures, and this gap in understanding is an important source of discrepancies in expectations and patient dissatisfaction . Ghomrawi and colleagues reported that approximately one-third of 205 patients undergoing primary TKA had higher expectations than their surgeons did. Being male and having lower preoperative pain was associated with having discordantly higher preoperative expectations . For realistic expectations to be set, patients need accurate and understandable information about expected positive outcomes of surgery such as level of function and symptom relief as well as the risk of joint failure, adverse events, complications, and activity limitations. Although little work has explored the alignment of patient and surgeon’s expectations, setting realistic expectations may be aided by using a shared decision making approach that incorporates patient preferences and values, the best available evidence, and the surgeon’s expertise.
Expectations and Willingness to Undergo Surgery
Although total joint replacement is an effective treatment for advanced arthritis, approximately 30% of potential candidates are “unwilling” to proceed with surgery [47,48]. Willingness is a component of the medical decision making process and is influenced by preferences. Potential surgical candidates unwilling to proceed with surgery tend to be older, female, and from ethnic minor-ity groups [12,47–49]. Preference-sensitive medical decisions, such as whether or not to proceed with TKA, are related to patients’ attitudes and perceptions, which can be affected by sociocultural influences. In a cohort of 627 male patients with moderate to severe OA who were viewed as “good” candidates for total joint arthroplasty, more African Americans (24%) than Caucasian Americans (15%) had lower expectations for outcomes of surgery . In particular, African Americans expressed concerns about postoperative pain and walking. Similar findings were also reported in another study in which minority patients were less likely to consider TKA . Determinants of preferences were patients’ beliefs about the efficacy of the procedure and knowing others who had already undergone TKA . Ibrahim and colleagues postulated that outcome expectations mediated or influenced the willingness to undergo total joint arthroplasty surgery . Interventional work that built upon this premise suggested that willingness to proceed with TKA could be modified by educational interventions. In a randomized controlled trial of 639 African American patients attending Veteran’s Affairs primary clinics who received a decision aid with or without brief counseling, willingness to proceed with TKA increased and patient-provider communication improved among the patients who received any intervention . Yet in another randomized trial involving African American patients who received care from an academic center, a combination decision aid and motivational interviewing strategy was no better than an educational pamphlet in improving patients’ preferences toward joint replacement surgery for knee OA . This led the authors to recommend further exploration of patients’ knowledge, beliefs, and attitudes regarding surgical treatments for OA.
Effect of Expectations on Health Outcomes and Satisfaction
Some evidence suggests that better outcomes are seen in patients with higher expectations of recovery and, in turn, expectations that are met influence patient satisfaction. A systematic review of several chronic conditions showed with consistency across studies that positive recovery expectations were associated with better health outcomes . The effect size varied with the condition and measure; however, none of the 16 studies examined arthritis or joint arthroplasty. Conversely, a systematic review of 18 prospective longitudinal cohort studies examining the association between expectation and outcomes (ie, pain, function, stiffness, satisfaction, overall improvement) reported less than convincing evidence of an association between patient preoperative expectations and treatment outcomes for THA and TKA in terms of short- and long-term postoperative pain and functional outcomes . No consistent associations were seen with adjusted analysis of patient expectations and pain or functional outcomes at greater than 6 weeks . Inconsistencies seen among the reviewed articles may be related to a number of issues centred on terminology, construct, expectation measures, and confounding effects.
Although TKA is an effective surgical procedure with large gains reported, 14% to 25% participants report little or no symptom improvement and/or dissatisfaction up to 1 year after surgery [1,52–59]. In a study with 5 years of follow-up, a decline in the satisfaction rate was seen after 1 year, although this decline was seen more so with physical function than with pain . Although dissatisfaction can be attributed to surgical complications, in many cases, no technical or medical reasons can be identified. In a subset of patients who received TKA, surgical intervention does not adequately address patients’ concerns of pain and activity limitation. To compound matters, fair agreement was reported between patient and surgeon regarding satisfaction at 6 and 12 months postoperative. Disagreement between the patient and surgeon was explained by unmet expectations and postoperative complications . When there was discordance, more often than not patients were less satisfied with TKA outcomes than surgeons [60,61].
While several theories explain patient satisfaction [62–65], evidence from total joint arthroplasty studies support the concept that satisfaction is derived from fulfillment of expectations [17,52]. Preoperative expectations are not to be confused with postoperative fulfilment of expectations, which are reflective of whether expectations of treatment have been met. Satisfaction is a value judgment and can be viewed as an affective domain, whereas expectation is a cognitive domain . Patient satisfaction is regarded as the extent of a person’s experience compared to their expectation. As with expectations, a number of theoretical constructs exist concerning patient satisfaction [14,67]. Many dimensions of satisfaction exist, with patient expectations being central to these constructs. Deviation from expectations, however, does not necessarily correspond to dissatisfaction .
Several patient-related factors are associated with satisfaction with TKA, including primary diagnosis, preoperative pain and function, and mental health, including depression, but the relationships of satisfaction with gender, age, and comorbid conditions are less certain [33,38,52,55,56,68]. Greater preoperative pain, postoperative complications, lower 1-year WOMAC scores and functional limitations were associated with dissatisfied patients [38,52,53,59]. While no consistent associations were seen with preoperative expectations, consistent evidence has shown that fulfillment of expectations has an impact on satisfaction [31,36,52,58,69].
It should be acknowledged that the concept of fulfillment of expectations is not the same as satisfaction. A patient can be satisfied with TKA even though their expectations have not been met. The fulfillment of expectations is dependent upon the type of expectation and the postoperative time period. Fulfillment of expectations were seen with pain relief, function, walking and health status [25,31,70] while patients expectations were not always met with leisure activities .
Shared Decision Making
The shared decision making process, in which the patient and physician share responsibility and actively participate in the clinical decision making process , may help in ensuring that patients’ expectations are met. Shared decision making requires eliciting patients’ preferences and values, providing clear information on the processes that will occur during surgery, recovery, rehabilitation, and in the longer phase of recovery, and what realistic outcomes can be expected. While a more “paternalistic” approach predominated in earlier years, the current trends indicate greater patient involvement in decision making with the surgeon, with open discussion of patient goals and expectations . This approach also aids patients in their preparation for the recovery and rehabilitation stages, which can be challenging, especially if they are unaware as to what to expect. Patient expectations are more likely to be met when there is shared decision making and patients have been given relevant information and understand what is a reasonable outcome. While a shared decision making approach is advocated within orthopedics , patient expectations are largely not measured in the clinical setting.
Patient education is an integral component of assisting patients to make informed decisions; however, it is unknown whether education alone can modify expectations. Educational approaches can include group classes, videos, and written materials . Limited evidence from a randomized controlled trial suggests that preoperative expectations can be modified by preoperative education classes by decreasing the number of expectations and having more expectations in agreement with the surgeons’ expectations . Mancuso and colleagues, who looked at whether a preoperative education session could modify expectations found that larger changes in expectations were seen with those patients who had greater baseline expectation scores, worse pain and function, and were older . Others have also reported that preoperative education reduces anxiety by providing patients with an understanding of what to expect [74,75]. An assumption is that expectations can be changed by improving knowledge, which underscores the need for relevant meaningful education to increase knowledge and instill realistic expectations. Others have surmised there is a proportion of patients who will continue to have unexpectedly high unrealistic expectations regardless of educational session [31,37]. This would suggest that education is not the only approach to modify expectations but rather different strategies may need to be implemented for a certain subsets of patients with unrealistic expectations.
Patient expectation is an important element to be considered in shared clinical decision making, as it can influ-ence preferences and subsequent satisfaction. Patients considering TKA have specific needs and expectations that they presume will be addressed with the surgery. If these are realistic, they can be met, and will result in greater patient satisfaction and better ongoing adherence to health care recommendations . While much work has been conducted in identifying which patient characteristics may influence health expectations, additional research is needed to further determine how to shape expectations within a realistic, achievable framework. While traditional patient education is an important element to enhance knowledge, the limited available evidence suggests it is not sufficiently effective on its own. Other strategies such as use of individualized decision aids, provision of peer support, and enhanced provider-patient communication have been effective in many areas of health care and warrant evaluation in this field.
Corresponding author: Allyson Jones, PhD, Rm 2-50, Corbett Hall, University of Alberta, Edmonton, Alberta Canada T6G 2G4, email@example.com.
Financial disclosures: None.
Author contributions: conception and design, CAJ, MES; analysis and interpretation of data, MES; drafting of article, CAJ, MES; critical revision of the article, CAJ, MES; collection and assembly of data, CAJ.
1. Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME. Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. J Rheumatol 2000;27:1745–52.
2. Waimann CA, Fernandez-Mazarambroz RJ, Cantor SB, et al. Cost-effectiveness of total knee replacement: a prospective cohort study. Arthritis Care Res 2014;66:592–9.
3. Jenkins PJ, Clement ND, Hamilton DF, et al. Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. Bone Joint J 2013;95:115–21.
4. Losina E, Walensky RP, Kessler CL, et al. Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med 2009;169:1113–21.
5. Cram P, Lu X, Kates SL, et al. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. JAMA 2012;308:1227–36.
6. Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89:780–5.
7. Jain NB, Higgins LD, Ozumba D, et al. Trends in epidemiology of knee arthroplasty in the United States, 1990-2000. Arthritis Rheum 2005;52:3928–33.
8. Engel C, Hamilton NA, Potter PT, Zautra AJ. Impact of two types of expectancy on recovery from total knee replacement surgery (TKR) in adults with osteoarthritis. Behav Med 2004;30:113–23.
9. Carr AJ, Robertsson O, Graves S, et al. Knee replacement. Lancet 2012;379:1331–40.
10. Skinner J, Weinstein JN, Sporer SM, Wennberg JE. Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients. N Engl J Med 2003;349:1350–9.
11. Cobos R, Latorre A, Aizpuru F, et al. Variability of indication criteria in knee and hip replacement: an observational study. BMC Musculoskelet Disord 2010;11:249.
12. Suarez-Almazor ME, Souchek J, Kelly PA, et al. Ethnic variation in knee replacement: patient preferences or uninformed disparity? Arch Intern Med 2005;165:1117–24.
13. Uhlmann RF, Inui TS, Carter WB. Patient requests and expectations. Definitions and clinical applications. Med Care 1984;22:681–5.
14. Bowling A, Rowe G, Lambert N, et al. The measurement of patients’ expectations for health care: a review and psychometric testing of a measure of patients’ expectations. Health Technology Assessment 2012;16:1–515.
15. Haanstra TM, van den Berg T, Ostelo RW, et al. Systematic review: do patient expectations influence treatment outcomes in total knee and total hip arthroplasty? Health Qual Life Outcomes 2012;10:152.
16. Zywiel MG, Mahomed A, Gandhi R, et al. Measuring expectations in orthopaedic surgery: a systematic review. Clin Orthop Rel Res 2013;471:3446–56.
17. Mancuso CA, Sculco TP, Wickiewicz TL, et al. Patients’ expectations of knee surgery. J Bone Joint Surg Am 2001;83A:1005–12.
18. Noble PC, Scuderi GR, Brekke AC, et al. Development of a new Knee Society scoring system. Clin Orthopaed Rel Res 2012;470:20–32.
19. Scuderi GR, Bourne RB, Noble PC, et al. The new Knee Society Knee Scoring System. Clin Orthop Relat Res 2012;470:3–19.
20. Saleh KJ, Bershadsky B, Cheng E, Kane R. Lessons learned from the hip and knee musculoskeletal outcomes data evaluation and management system. Clin Orthop Relat Res 2004; 272–8.
21. Razmjou H, Finkelstein JA, Yee A, et al. Relationship between preoperative patient characteristics and expectations in candidates for total knee arthroplasty. Physiotherapy Canada 2009;61:38–45.
22. Mondloch MV, Cole DC, Frank JW. Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes. CMAJ 2001;165:174–9.
23. Wright JG, Santaguida PL, Young N, et al. Patient preferences before and after total knee arthroplasty. J Clin Epidemiol 2010;63:774–82.
24. Mahomed NN, Liang MH, Cook EF, et al.: The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatology 2002;29:1273–9.
25. Gonzalez Saenz de Tejada M, Escobar A, Herrera C, et al. Patient expectations and health-related quality of life outcomes following total joint replacement. Value Health 2010;13:447–54.
26. Hepinstall MS, Rutledge JR, Bornstein LJ, et al. Factors that impact expectations before total knee arthroplasty. J Arthroplasty 2011;26:870–6.
27. Muniesa JM, Marco E, Tejero M, et al. Analysis of the expectations of elderly patients before undergoing total knee replacement. Arch Gerontol Geriatr 2010;51:E83-E87.
28. Lingard EA, Sledge CB, Learmonth ID. Patient expectations regarding total knee arthroplasty: Differences among the United States, United Kingdom, and Australia. J Bone Joint Surg Am 2006;88:1201–7.
29. Mancuso CA, Graziano S, Briskie LM, et al. Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties. Clin Orthopaed Rel Res 2008;466:424–31.
30. de AS, Kallen MA, Amick B, et al. Patients’ expectations about total knee arthroplasty outcomes. Health Expect 2016;19:299–308.
31. Mannion AF, Kampfen S, Munzinger U, Kramers-de Q. The role of patient expectations in predicting outcome after total knee arthroplasty. Arthritis Res Ther 2009;11:R139.
32. Yoo JH, Chang CB, Kang YG, et al. Patient expectations of total knee replacement and their association with sociodemographic factors and functional status. J Bone Joint Surg Br 2011;93:337–44.
33. Ethgen O, Bruyere O, Richy F, et al. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004;86:963–74.
34. Jones CA, Pohar S. Health-related quality of life after total joint arthroplasty: a scoping review. Clin Geriatr Med 2012;28:395–429.
35. Groeneveld PW, Kwoh CK, Mor MK, et al. Racial differences in expectations of joint replacement surgery outcomes. Arthritis Rheum 2008;59:730–7.
36. Scott CEH, Bugler KE, Clement ND, et al. Patient expectations of arthroplasty of the hip and knee. J Bone Joint Surg Br 2012;94:974–81.
37. Smith J, Soon VL, Boyd A, et al. What do Scottish patients expect of their total knee arthroplasty? J Arthroplasty 2016;31:786–92.
38. Nilsdotter AK, Toksvig-Larsen S, Roos EM. Knee arthroplasty: are patients’ expectations fulfilled? A prospective study of pain and function in 102 patients with 5-year follow-up. Acta Orthopaedica 2009;80:55–61.
39. Alarcon GM, Bowling NA, Khazon S. Great expectations: A meta-analytic examination of optimism and hope. Person Ind Diff 2013;54:821–7.
40. Pinto P, McIntyre T, Ferrero R, et al. Predictors of acute postsurgical pain and anxiety following primary total hip and knee arthroplasty. J Pain 2013;14:502–15.
41. Devilly GJ, Borkovec TD. Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry 2000;31:73–86.
42. Haanstra TM, Tilbury C, Kamper SJ, et al. Can optimism, pessimism, hope, treatment credibility and treatment expectancy be distinguished in patients undergoing total hip and total knee arthroplasty? PLoS One 2015;10.
43. Verbeek J, Sengers MJ, Riemens L, Haafkens J.Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies. Spine 2004; 29:2309–18.
44. Ghomrawi HM, Mancuso CA, Westrich GH, et al. Discordance in TKA expectations between patients and surgeons. Clin Orthopaed Rel Res 2013;471:175–80.
45. Cordero-Ampuero J, Darder A, Santillana J, et al. Evaluation of patients’ and physicians’ expectations and attributes of osteoarthritis treatment using Kano methodology. Qual Life Res 2012;21:1391–404.
46. Noble PC, Fuller-Lafreniere S, Meftah M, Dwyer MK. Challenges in outcome measurement: discrepancies between patient and provider definitions of success. Clin Orthopaed Rel Res 2013;471:3437–45.
47. Hawker GA, Wright JG, Coyte PC, et al. Determining the need for hip and knee arthroplasty: the role of clinical severity and patients’ preferences. Med Care 2001;39:206–16.
48. Juni P, Dieppe P, Donovan J, et al. Population requirement for primary knee replacement surgery: a cross-sectional study. Rheumatology 2003;42:516–21.
49. Ibrahim SA, Siminoff LA, Burant CJ, Kwoh CK. Differences in expectations of outcome mediate African American/white patient differences in “willingness” to consider joint replacement. Arthritis Rheum 2002;46:2429–35.
50. Ibrahim SA, Hanusa BH, Hannon MJ, et al. Willingness and access to joint replacement among African American patients with knee osteoarthritis: a randomized, controlled intervention. Arthritis Rheum 2013;65:1253–61.
51. Vina ER, Richardson D, Medvedeva E, et al. Does a patient-centered educational intervention affect African-American access to knee replacement? A randomized trial. Clin Orthop Relat Res 2016;474:1755–64.
52. 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; 35–43.
53. Robertsson O, Dunbar M, Pehrsson T, et al. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 2000;71:262–7.
54. Lau RL, Gandhi R, Mahomed S, Mahomed N. Patient satisfaction after total knee and hip arthroplasty. Clin Geriatr Med 2012;28:349–65.
55. Scott CEH, Howie CR, Macdonald D, Biant LC. Predicting dissatisfaction following total knee replacement. A prospective study of 1217 patients. J Bone Joint Surg Br 2010; 92B:1253–8.
56. Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br 2007;89:893–900.
57. Khatib Y, Madan A, Naylor JM, Harris IA: Do psychological factors predict poor outcome in patients undergoing TKA? a systematic review. Clin Orthopaed Rel Res 2015;473:2630–8.
58. Adie S, Dao A, Harris IA, et al. Satisfaction with joint replacement in public versus private hospitals: a cohort study. ANZ J Surg 2012;82:616–24.
59. Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 2010;468:57–63.
60. Harris IA, Harris AM, Naylor et al. Discordance between patient and surgeon satisfaction after total joint arthroplasty. J Arthroplasty 2013;28:722–7.
61. Choi YJ, Ra H. Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 2016;28:1–15.
62. Williams B. Patient satisfaction: a valid concept? Soc Sci Med 1994;38:509–16.
63. Ware JE Jr, Snyder MK, Wright WR, Davies AR. Defining and measuring patient satisfaction with medical care. Eval Program Plann 1983;6:247–63.
64. Linder-Pelz SU. Toward a theory of patient satisfaction. Soc Sci Med 1982;16:577–82.
65. Hudak PL, Hogg-Johnson S, Bombardier C, et al. Testing a new theory of patient satisfaction with treatment outcome. Med Care 2004;42:726–39.
66. Thompson AG, Sunol R. Expectations as determinants of patient satisfaction: concepts, theory and evidence. Int J Qual Health Care 1995;l7:127–41.
67. Pascoe GC. Patient satisfaction in primary health care: a literature review and analysis. Eval Program Plann 1983;6:185–210.
68. Gandhi R, Davey JR, Mahomed NN. Predicting patient dissatisfaction following joint replacement surgery. J Rheumatol 2008;35:2415–8.
69. Waljee J, McGlinn EP, Sears ED, Chung KC. Patient expectations and patient-reported outcomes in surgery: A systematic review. Surgery 2014;155:799-808.
70. Suda AJ, Seeger JB, Bitsch RG, et al. Are patients’ expectations of hip and knee arthroplasty fulfilled? A prospective study of 130 patients. Orthopedics 2010;33:76.
71. Slover J, Shue J, Koenig K. Shared decision-making in orthopaedic surgery. Clin Orthopaed Rel Res 2012;470:1046–53.
72. Weinstein JN. The missing piece: embracing shared decision making to reform health care. Spine 2000;25:1–4.
73 Aydin D, Klit J, Jacobsen S, et al. No major effects of preoperative education in patients undergoing hip or knee replacement–a systematic review. Dan Med J 2015;62.
74. Spalding NJ. Reducing anxiety by pre-operative education: make the future familiar. Occup Ther Int 2003;10:278–93.
75. Kearney M, Jennrich MK, Lyons S, et al. Effects of preoperative education on patient outcomes after joint replacement surgery. Orthop Nurs 2011;30:391–6.
76. Sherbourne CD, Hays RD, Ordway L, et al. Antecedents of adherence to medical recommendations: results from the Medical Outcomes Study. J Behav Med 1992;15:447–68.
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