The dramatic increase in utilization of total joint arthroplasty (TJA) (doubled between 1998-2005) has been accompanied by a change in patient's demographic profile. TJA is increasingly being utilized by younger and less functionally debilitated individuals who expect more from the surgery. Knowing that unmet expectations are associated with dissatisfaction and potentially inferior function, addressing these increasing expectations and setting realistically achievable goals for the surgery becomes a real challenge. While surgeons aim to guide expectations through discussions with their patients so surgeons and patients agree on the goals of surgery, the degree to which they are aligned and what impact that discordance has on outcomes and in which subpopulations of patients remains poorly understood. Therefore, the proposed research will evaluate the impact of discordance in expectations on TJA immediate and long-term functional outcomes. The mentored phase of this proposal will evaluate the degree to which the phenomenon of discordance exists and what its correlates are. The independent phase will develop predictive models to examine the effect of this discordance on immediate as well as short and long-term outcomes. This study will use data from the Hospital for Special Surgery (HSS) CERT TJA registry, which was established in 2007 with support from AHRQ and has thus far enrolled more than 8000 patients. Subjects are evaluated preoperatively and followed up at 6 months and 2 years to assess satisfaction and changes in function. Expectations will be measured preoperatively using the validated HSS TJA expectations surveys.

Public Health Relevance

Results of this study will help identify subpopulations of patients whose expectations may have a clinically meaningful effect on their outcomes, if they were discordant with those of their surgeons, and feed this information into targeted interventions such as the preoperative educational class so that expectations are realistically achievable.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Transition Award (R00)
Project #
5R00HD060686-04
Application #
8259126
Study Section
Special Emphasis Panel (NSS)
Program Officer
Quatrano, Louis A
Project Start
2010-02-03
Project End
2014-01-31
Budget Start
2012-02-01
Budget End
2013-01-31
Support Year
4
Fiscal Year
2012
Total Cost
$181,580
Indirect Cost
$100,138
Name
Weill Medical College of Cornell University
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
060217502
City
New York
State
NY
Country
United States
Zip Code
10065
Ghomrawi, Hassan M K; Mancuso, Carol A; Westrich, Geoffrey H et al. (2013) Discordance in TKA expectations between patients and surgeons. Clin Orthop Relat Res 471:175-80