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Patient Expectations Regarding Total Knee Arthroplasty: Differences Among the United States, United Kingdom, and Australia
Elizabeth A. Lingard, BPhty, MPhil, MPH1; Clement B. Sledge, MD2; Ian D. Learmonth, FRCS3
1 School of Surgical and Reproductive Sciences (Trauma and Orthopaedics), The Medical School, University of Newcastle upon Tyne, NE2 4HH, United Kingdom. E-mail address for E.A. Lingard: Liz.Lingard@nuth.northy.nhs.uk
2 Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
3 Department of Orthopaedic Surgery, University of Bristol, Winford Unit, Avon Orthopaedic Centre, Bristol BS10 5NB, United Kingdom
View Disclosures and Other Information
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Stryker Howmedica, Mahwah, NJ, and Limerick, Ireland. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Stryker Howmedica, Mahwah, NJ, and Limerick, Ireland). Also, a commercial entity (Stryker Howmedica, Mahwah, NJ, and Limerick, Ireland) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Kinemax Outcomes Group includes: William Gillespie, Colin Howie, Ian Annan, Alastair Gibson, and Judith Lane (Princess Margaret Rose Hospital, Edinburgh, Scotland); Ian Pinder, David Weir, Nigel Brewster, Karen Bettinson, and Sheryl Mitchell (Freeman Hospital, Newcastle upon Tyne, England); Maurice Needhoff and Roz Jackson (King's Mill Centre, Mansfield, England); Tim Wilton and Peter Howard (Derbyshire Royal Infirmary, Derby, England); Ian Forster, Paul Szyprt, Chris Moran, David Whitaker, Mike Bullock, and Zena Hinchcliffe (Queen's Medical Centre, Nottingham, England); Ian Learmonth, John Newman, Chris Ackroyd, George Langkamer, Robert Spencer, Mark Shannon, Evert Smith, John Dixon, and Sarah Whitehouse (Avon Orthopedic Centre, Bristol, England); Clement Sledge, Frederick Ewald, Robert Poss, John Wright, Scott Martin, John Kwon, and Yvette Valderamma (Brigham and Women's Hospital, Boston, MA); Steven Harwin and Michael Lichardi (Beth Israel Medical Center, New York, NY); Mark Mehlhoff, Linda Weiler, and Tom Cahalan (Iowa Medical Clinic, Cedar Rapids, IA); Richard Cronk and Allyson Sandago (Neuromuscular and Joint Center, Corvallis, OR); Stephen Rackemann and Emma McLaughlin (The Knee Centre, Gold Coast, QLD, Australia); and Peter Lewis, Robert Bauze, Gordon Morrison, Tom Stevenson, and Jane Stirling (Queen Elizabeth Hospital, Adelaide, SA, Australia).
Investigation performed at Brigham and Women's Hospital, Boston, Massachusetts, and the School of Surgical and Reproductive Sciences (Trauma and Orthopaedics), University of Newcastle upon Tyne, England

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Jun 01;88(6):1201-1207. doi: 10.2106/JBJS.E.00147
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Background: Total knee arthroplasty is an effective treatment for severe osteoarthritis of the knee. Our aim was to determine whether patients from the United Kingdom, United States, and Australia have different preoperative expectations regarding total knee arthroplasty and whether these expectations have an impact on outcomes and patient satisfaction.

Methods: Patients from the United Kingdom, the United States, and Australia were recruited into a prospective observational study of primary total knee arthroplasty for the treatment of osteoarthritis. Preoperative expectations, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-36 (SF-36) scores, and demographic, socioeconomic, and follow-up data, including satisfaction with outcome, were obtained from self-administered patient questionnaires.

Results: A total of 598 patients with a mean age of sixty-nine years at the time of the index arthroplasty were recruited; 58% were women. The majority of patients expected to have no pain at twelve months after the surgery, and with the numbers available there was no significant difference among the countries with regard to pain expectations. Australian patients were more likely than patients in the United Kingdom or the United States to expect better function at twelve months after the surgery. With the numbers available, satisfaction scores at twelve months did not differ significantly among the countries and were not influenced by preoperative expectations. Australian patients were more likely than patients in the United Kingdom or the United States to be unwilling to undergo total knee arthroplasty again at twelve months under similar circumstances.

Conclusions: Patients from different countries have different expectations regarding total knee arthroplasty, which are not fully explained by differences in sociodemographic factors, clinical characteristics, and pain and functional status. Australian patients had the highest expectations but, despite reporting similar outcomes and satisfaction following total knee arthroplasty, they were more likely not to want to have the surgery again under similar circumstances.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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