JMIR Publications

ABSTRACT

Background:

Patient satisfaction with total knee arthroplasty (TKA) is strongly influenced by alignment between expectations and outcomes. Despite a satisfaction rate of 80-90%, dissatisfaction affects 10-20% of patients and is expected grow with the increasing volume of TKA procedures globally. Misaligned expectations, often driven by unrealistic or overly optimistic recovery views, can lead to unmet goals, dissatisfaction and unnecessary healthcare utilisation. Addressing these gaps through improved pre-surgical education has the potential for enhancing patient satisfaction, optimising outcomes and reducing burden on the healthcare system.

Objective:

The main objectives of this study are to develop and evaluate a pre-surgical educational program, which focusses on patient expectations of surgical outcomes, and facilitates patients setting realistic post-surgical goals. We will also assess ability of the program to modify patient expectations, impact expectation fulfillment, improve satisfaction with post-surgical outcomes and impact patient health literacy.

Methods:

An education program will be developed in consultation with key stakeholder groups including consumer advocates, orthopaedic surgeons, healthcare providers, physiotherapy and rehabilitation specialists to address realistic patient expectations of TKA outcomes. Alpha testing with consumers will provide insights of the appropriateness of the program being developed. The ability of the program to modify patient expectation will be assessed in a longitudinal, parallel group, two-armed randomized controlled trial, involving 150 patients identified by their orthopaedic surgeon as requiring TKA. Randomly allocated participants will take part in the education program within 5 weeks prior to their scheduled TKA (intervention group) or will be allocated to standard preoperative education (control group). The primary outcome will be a change in the Hospital for Special Surgery Total Knee Replacement Expectations Survey (HSS-TKA) transformed score measured prior to and following the intervention. At 6 months following TKA, expectation fulfillment and overall satisfaction will be measured. Inferential statistics will be used to test for differences in, or associations between, outcome measures within and between study arms. Methods appropriate to both dependent and independent samples will be utilised, including non-parametric methods for data in violation of normality and variance assumptions.

Results:

The education program will be developed from January to September 2025. The randomized trial will run from October 2025 to March 2027, with data analysis completed by April 2027 and results published in peer-reviewed journals by September 2027.

Conclusions:

This study will provide evidence on the effectiveness of a novel pre-surgical educational program in shaping patient expectations, promoting realistic goal setting, and improving TKA satisfaction. Findings will inform strategies to improve TKA patient care, health literacy and satisfaction, potentially reducing dissatisfaction and associated burden on healthcare. Clinical Trial: Australian New Zealand Clinical Trials Registry number: ACTRN12624001465549p