Disease burden of and expectations from surgery in patients prior to total knee arthroplasty: Results of the prospective FInGK study

•Disease burden of patients undergoing TKA for osteoarthritis shows large variations.•92% of those with a low disease burden expected high pain relief following TKA.•Logistic regression revealed several factors associated with low disease burden including male sex, not being depressed and a shorter duration of complaints.•73% with a low disease burden did not receive physiotherapy in the year before TKA. Disease burden in patients prior to total knee arthroplasty (TKA) varies widely between studies and countries. We aimed to characterize individuals undergoing TKA and examine their expectations from the surgery, focusing on variations in disease burden. Consecutive patients undergoing primary TKA in a German university hospital were recruited. A questionnaire including information on disease burden, preoperative expectations from surgery, health care utilization, demography, and socioeconomics was collected one day prior to surgery and linked to data from medical records. Patients were categorized into disease burden quartiles using the Western Ontario and McMaster Universities Osteoarthritis Index’ (WOMAC) total score. Subsequently, study population’s characteristics and expectations from surgery were analyzed stratified by disease burden. A total of 196 patients were included (41 % male; mean age: 68.2 years). The median WOMAC was 52.0 (IQR: 41.0–58.0). Patients in Q1 were more often males (Q1: 63 % vs Q4: 29 %) and had a shorter duration of complaints with the impaired knee. They were also less restricted in social participation, reported less often signs of depression, and were less often treated with physiotherapy (Q1: 27 % vs Q4: 54 %). Furthermore, expectations from surgery were highest in patients with a low disease burden. We found large variations in disease burden with a considerable number of patients undergoing TKA whose functional capacity is still maintained and for which guideline-recommended conservative treatment options are not fully exhausted. Further research on this subgroup as well as establishing an international consensus on specific thresholds for TKA indication are needed.