Evaluation of the Factors Affecting Concerns and Expectations of Patients Undergoing Total Knee Arthroplasty in China

BACKGROUND: The aim of this study was to assess the level of concern and expectations of patients and their families of total knee arthroplasty (TKA), peri-operative procedures, postoperative rehabilitation, and outcome in a Chinese population. MATERIAL/METHODS: The study recruited 133 patients with osteoarthritis, scheduled to undergo primary elective TKA. Before surgery, the surgeon completed the Hospital for Special Surgery (HSS) Knee Score questionnaire on pain, function, range of motion (ROM), and muscle strength. There were 128 patients and 127 family members (spouses, sons, or daughters) who completed the 24-item Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire on pain, stiffness, and physical function, and also a 61-item questionnaire that included direct questions on their concerns and expectations on TKA and its outcome, using scores of: 1, not concerned; 2, somewhat concerned; 3, very concerned; and 4, extremely concerned. RESULTS: The five greatest pre-operative concerns for patients included the degree of postoperative mobility; the experience and expertise of their surgeon; the risk of failure of TKA; the duration of the joint implant; and their expected degree of postoperative independence. Scores for Chinese patients indicated a higher level of concern compared with Western patients. Family members were significantly more concerned than patients regarding the postoperative restoration of knee function and alleviation of pain (p=0.001), the ability to squat (p=0.049) and to kneel (p=0.039). CONCLUSIONS: Communicating pre-operative information on TKA might result in realistic expectations for patients and their families, alleviate concerns, and improve relationships between doctors and patients.