PATIENT EXPECTATIONS OF TOTAL HIP ARTHROPLASTY HAVE INCREASED OVER THE PAST QUARTER OF A CENTURY

The important of assessing pre-operative patient expectations in patients being considered for total hip arthroplasty (THA) is well recognized, being an important independent predictor of improved functional outcomes and satisfaction following surgery. Over the past decades, many aspects of THA surgery have changed. This includes improved perioperative pain management, earlier mobilization, shorter hospital stays, newer generation implants and surgical techniques. However, it is unclear whether patient expectations of these procedures have changed as well. Thus, the purpose of this study was to investigate changes over time in patients’ expectations of hip arthroplasty, as well as both pre-operative functional status and post-operative satisfaction. We performed a retrospective analysis of two prospectively collected databases to identify those patients who underwent primary unilateral THA at a single institution between January 1998 and December 2019. All patients enrolled in these databases completed a range of patient reported expectation and outcome measures pre-operatively, as well as at regular intervals after surgery. This included a series of 8 questions regarding their expectations of surgery obtained pre-operatively, and 5 questions regarding satisfaction at 3 months and 1 year post-operatively. We extracted demographic data including age, gender and year of surgery, pre and post-operative Hip Osteoarthritis Outcome Scores (HOOS), pre-operative expectations, and post-operative satisfaction. Data were stratified by year of surgery, and correlation analyses were performed to evaluate changes in both baseline and post-operative measures over time. We identified 3643 (mean age, 66 years) patients who underwent THA between January 1998 and December 2019. Among these patients, there was a moderate trend for increased mean age over time (r=0.49; p=0.02) but no change in gender, BMI or baseline HOOS scores. There was a general trend toward higher expectations of surgery over time. Specifically, there was a trend to expecting fewer limitations with usual activities once fully recovered (r=0.51; p=0.01), and being more likely to have a completely successful surgery (r=0.42; p=0.05). Despite these increasing expectations, no negative trend was seen in either 3 month (r= -0.20; p=0.35) or 1 year (r= -0.02; p=0.92) satisfaction. Patient expectations of total hip arthroplasty have evolved over the past quarter century, with increasing expectations in terms of functional status at maximal recovery and the likelihood of a completely successful surgery. This is despite minimal change over time in either baseline demographic profile or functional status. Furthermore, no decrease was seen over time in patient satisfaction with THA at both 3 months and 1 year after surgery. This suggests that the greater expectations may reflect advances in arthroplasty patient selection, optimization and perioperative care achieved over the same time period.