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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (1): 170-176. doi: 10.19723/j.issn.1671-167X.2022.01.027

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Patient factors influencing preoperative expectations of patients undergoing total knee arthroplasty

LI Zhi-chang,HOU Yun-fei,ZHOU Zhi-wei,JIANG Long,ZHANG Shu,LIN Jian-hao()   

  1. Institute of Arthritis, Peking University People’s Hospital, Beijing 100044, China
  • Received:2021-01-13 Online:2022-02-18 Published:2022-02-21
  • Contact: Jian-hao LIN E-mail:linjianhao@pkuph.edu.cn

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Abstract:

Objective: To investigate the expectations of patients for total knee arthroplasty (TKA), and to analyze its influencing factors. Methods: Experimental design: Single center, retrospective, multiple regression analysis. The data including the age, height, and weight of 108 patients undergoing unilateral TKA due to end-stage osteoarthritis were obtained. The patients’ preoperative Hospital for Special Surgery (HSS) knee arthroplasty expectation score, the Western Ontario and McMaster Universities (WOMAC) score, Knee Society score (KSS), the MOS 36-item short-from health survey (SF-36) score, and visual analogue scale (VAS) were evaluated, and the 30-second chair-stand test (30-CST), 40-meter fast-paced walk test (40-FPWT), 12-level stair-climb test (12-SCT), 3-meter timed up-and-go test (TUG), 6-minute walk test (6-MWT), and recorded daily steps for 7 consecutive days were performed. The SPSS 22.0 software was used for statistical analysis. The observed values of various data were described. Pearson correlation analysis was used to evaluate the correlation between various parameters, and the multi-factor linear regression analysis was used to investigate the influencing factors of the patients preoperative expectation scores. Results: The average expectation score of this group of patients was 58.98±5.44. In the Pearson correlation analysis, the patient’s preoperative expectation had a weak correlation to the result of the patient’s 12-SCT, TUG, 6-MWT, KSS function score, and SF-36 mental component score (correlation coefficient 0.1-0.3). The patient’s preoperative expectation had a moderate correlation to the patient’s daily average steps, 30-CST, 40-FPWT, KSS, WOMAC and its pain, stiffness, function scores, SF-36 physical functioning, role-physical, bodily pain, vitality, and physical component score (correlation coefficient 0.3-0.6). In the multivariate linear regression analysis, only the results of 30-CST and the role-physical, bodily pain and vitality in the SF-36 scale were related to the patient’s expectation score (P<0.05). Conclusion: The estimated expectation score of patients before TKA is not high. Patients with more severe preoperative pain, worse physical function, and lower overall health are more eager to improve after surgery. Thus surgeons must communicate fully with patients with unrealistic expectations before surgery in order to obtain more satisfactory results postoperatively.

Key words: Arthroplasty, replacement, knee, Patient satisfaction, Recovery of function, Activities of daily living

CLC Number: 

  • R687.4

Table 1

Preoperative parameters of patients and their correlation with the estimated surgical expectations"

Items Mean Standard deviation Minimum Maximum Correlation coefficient P value
Expectations 58.98 5.44 48.00 74.00
Age 64.88 4.42 48.00 77.00 -0.110 0.256
BMI 27.50 1.94 23.59 31.96 0.182 0.059
Steps 1 959.28 752.00 316.71 4 742.29 -0.444 <0.001
PBTs
30-CST 2.66 1.15 0 6.00 -0.312 0.001
40-FPWT 47.76 15.77 22.00 99.12 0.424 <0.001
12-SCT 25.28 4.69 15.67 40.63 0.249 0.009
TUG 10.10 1.67 7.34 14.33 0.299 0.002
6-MWT 215.74 50.97 98.00 331.00 -0.298 0.002
WOMAC 42.03 7.15 27.00 63.00 0.503 <0.001
Pain_WOMAC 10.82 2.54 6.00 19.00 0.495 <0.001
Stiff_WOMAC 2.61 1.70 0 7.00 0.508 <0.001
Function_WOMAC 28.59 4.26 18.00 38.00 0.346 <0.001
KSS 34.76 9.91 1.00 51.00 -0.465 <0.001
KSS-F 36.39 15.75 0 70.00 -0.295 0.002
SF-36
PF 43.01 7.36 30.00 60.00 -0.431 <0.001
RP 42.82 32.43 0 100.00 -0.322 0.001
BP 35.66 11.87 12.00 52.00 -0.585 <0.001
GH 57.62 7.14 37.00 77.00 -0.075 0.438
VT 57.59 6.71 35.00 70.00 -0.599 <0.001
SF 45.14 11.82 25.00 75.00 -0.054 0.578
RE 55.25 29.24 0 100.00 -0.095 0.327
MH 61.41 3.99 52.00 68.00 -0.076 0.433
PCS 44.78 10.51 21.75 63.25 -0.502 <0.001
MCS 54.85 8.01 36.25 72.50 -0.242 0.012
VAS 5.41 1.45 2.00 8.00 0.353 <0.001

Figure 1

Distribution of the expectation scores of the total knee arthroplasty"

Figure 2

The scores of each items of HSS knee replacement expectations survey HSS, Hospital for Special Surgery."

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