There was no consistency in the association between patients' pre-operative expectations and treatment outcomes for TKA and THA indentified in this systematic review.
Patient satisfaction is related to the patient's pre-operative expectations and the quality of care given during the hospital stay and follow-up [ 10].
To our knowledge, there are a few comparable studies that explore the association between pre-operative expectations and change in HRQoL for TJR [ 12].
A recent study has shown patients describing these activities as 'very important' and that their post-operative expectations to perform them are often unfulfilled.
The association between pre-operative expectations and one or more out of 5 different treatment outcomes namely overall improvement, pain, function, stiffness and satisfaction had to be tested either in a unadjusted or adjusted analysis.
Along the same line, Judge et al. [ 47] in a study of 1327 primary total hip replacement (THR) explored whether pre-operative expectations predict surgical outcomes in terms of pain and function measured by WOMAC 12 months post THR.
Studies have shown that the most positive outcomes post-surgery are observed for patients with greater pre-operative function [ 57], higher pre-operative expectations [ 58] where disease pre-surgery is less severe [ 57]; factors more likely seen in non-obese rather than obese patients, and therefore higher SES groups compared to lower SES groups.
Previous studies have shown that 10%to25%5% of patients are dissatisfied with the outcome of knee replacement at one to three years after surgery, primarily because of the presence of residual symptoms and the failure of the procedure to meet the patient's pre-operative expectations.
A systematic review could provide clarity as to which types of expectations are associated with which outcomes at which time points and thereby may inform researchers and orthopaedic clinicians in their usage of patients' pre-operative expectations as a possible predictor of outcomes.
From this work, it proved to be difficult to use such scores as a single proxy of outcome because the results of disease-specific scores were affected by the general health of patients as well as their satisfaction with the surgery, which again is related to pre-operative expectations.
The measurement of both the pre-operative expectation variable and the satisfaction variable differed highly amongst the studies.
