Fulfillment of Patients' Expectations for Total Hip Arthroplasty

Background: Fulfillment of patient expectations is an important outcome of total hip arthroplasty. The objective of the present study was to determine the proportion of expectations that were fulfilled following total hip arthroplasty as well as how the fulfillment of expectations relates to patient and clinical characteristics. Methods: Preoperatively, patients completed the Hospital for Special Surgery Hip Replacement Expectations Survey, measuring physical and psychological expectations, and the American Academy of Orthopaedic Surgeons Lower Limb Core Scale, measuring symptoms and function. Approximately four years after surgery, patients were interviewed by telephone and were asked whether each expectation that they had cited preoperatively had been fulfilled. Results: Four hundred and five patients were interviewed. The mean age of the patients was sixty-six years, and 58% of the patients were women. Forty-three percent of the patients reported that all of their expectations had been fulfilled completely. For the entire sample, the mean proportion of expectations that had been fulfilled completely was 87%. Patients who were younger, who were employed, who had a body mass index of <35 kg/m(2), who did not have complications, who did not have a postoperative limp, and who had better preoperative and postoperative Lower Limb Core scores had a greater proportion of expectations fulfilled (p <= 0.05). Conclusions: A better postoperative Lower Limb Core score was most closely associated with the fulfillment of expectations following total hip arthroplasty. Not having a postoperative limp was independent of the postoperative Lower Limb Core score, indicating that the impact of a limp is greater than its manifestation as a physical disability. Better preoperative status also was an independent predictor, indicating that patient expectations are more likely to be fulfilled if the patient is not the most severely impaired at the time of surgery.