Higher Patient Expectations Predict Higher Patient Reported Outcomes, but not Satisfaction, in Total Knee Arthroplasty Patients: a Prospective Multi-Center Study

Abstract Background The relationship between patient expectations, patient reported outcomes (PROs), and satisfaction in TKA patients is not well understood. Methods We prospectively evaluated patients who underwent primary TKA across four institutions. Demographics were collected. Preoperatively, patients completed the Hospital for Special Surgery Knee Replacement Expectations Survey (HSS-KRES), SF-12, UCLA activity, and Knee Disability and Osteoarthritis Score (KOOS). At 6 months and 1 year postoperatively, patients completed the Hospital for Special Surgery Knee Replacement Fulfillment of Expectations Survey (HSS-KRFES), a satisfaction survey, and PROs. Step-wise multivariate regression models were created. Results 83 patients were enrolled. At 6 months and 1 year postoperatively, the follow up rate was 84.3% and 92.7%, respectively. No demographics or preoperative PROs were predictive of HSS-KRES. Preoperative HSS-KRES did not predict postoperative satisfaction, but higher HSS-KRES predicted higher HSS-KRFES at 1 year, greater improvement in UCLA activity at 6 months and 1 year, and SF-12 PCS and KOOS at 6 months. Higher HSS-KRFES predicted higher satisfaction at 6 months and 1 year. Conclusion In TKA patients, preoperative expectations are not influenced by patient demographics or preoperative function. Higher preoperative expectations predict greater postoperative improvement in PROs and fulfillment of expectations. These findings highlight the importance of preoperative patient expectations on postoperative outcome.