The dramatic increase in utilization of total joint arthroplasty (TJA) (doubled between1998-2005) has been accompanied by a change in patient's demographic profile. TJA isincreasingly being utilized by younger and less functionally debilitated individuals whoexpect more from the surgery. Knowing that unmet expectations are associated withdissatisfaction and potentially inferior function, addressing these increasing expectationsand setting realistically achievable goals for the surgery becomes a real challenge. Whilesurgeons aim to guide expectations through discussions with their patients so surgeonsand patients agree on the goals of surgery, the degree to which they are aligned andwhat impact that discordance has on outcomes and in which subpopulations of patientsremains poorly understood. Therefore, the proposed research will evaluate the impact ofdiscordance in expectations on TJA immediate and long-term functional outcomes.The mentored phase of this proposal will evaluate the degree to which the phenomenonof discordance exists and what its correlates are. The independent phase will developpredictive models to examine the effect of this discordance on immediate as well asshort 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 morethan 8000 patients. Subjects are evaluated preoperatively and followed up at 6 monthsand 2 years to assess satisfaction and changes in function. Expectations will bemeasured preoperatively using the validated HSS TJA expectations surveys.
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.
| Ghomrawi, Hassan M K; Mancuso, Carol A; Dunning, Allison et al. (2017) Do Surgeon Expectations Predict Clinically Important Improvements in WOMAC Scores After THA and TKA? Clin Orthop Relat Res 475:2150-2158 |
| 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 |
| Ghomrawi, Hassan M K; Franco Ferrando, Nuria; Mandl, Lisa A et al. (2011) How Often are Patient and Surgeon Recovery Expectations for Total Joint Arthroplasty Aligned? Results of a Pilot Study. HSS J 7:229-34 |
