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.