Fulfilment of patient-rated expectations predicts the outcome of surgery for femoroacetabular impingement

Objective: The aim of this study was to explore the role of expectations in relation to patient-rated global treatment outcome in patients undergoing hip preservation surgery for femoroacetabular impingement (FAI). Method: Pre-operatively, 86 patients completed the Oxford Hip Score (OHS), a question about the motivation for undergoing surgery, and Likert-scales rating the improvement expected in various domains (pain, general function, sport, walking capacity, independence, social function, mental well-being). 12-months post-operatively, they rated the actual perceived improvement in each domain and the global outcome of surgery (GTO, 5-point Likert-scale: operation "helped a lot" through to "made things worse"), and completed the OHS again. Results: The most frequent "top reason" for surgery was "alleviation of pain", being indicated by 33% patients; 20% patients chose "fear of worsening", 16% "improvement in everyday activities", 11% "other therapies failed", 10% "improvement in sporting activities" and 10% other. The 12-month data revealed prior expectations had been overly optimistic in more than 50% patients for hip pain, sport, and general physical capacity, and in 33-45% patients for independence, mental well-being, and walking capacity. Multiple regression revealed significant (P < 0.05) unique associations between GTO and "fulfilled expectations" for pain and sport (explaining 47% and 12% variance, respectively). Conclusion: Expectations of surgery were overly optimistic. Having one's expectations fulfilled, especially in relation to pain, was important for a good outcome. The results emphasise the benefit of assessing patient-orientated outcome in routine practice and the factors that might influence it, such that realistic expectations can be established for patients prior to surgery. (C) 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.