Clinical decision-making is often based on evidence of outcome after a specific treatment. Surgeons and patients may, have different perceptions and expectations of what to achieve following a Total Hip Replacement (THR). Several studies have shown that unfulfilled expectations are a principal source of patient dissatisfaction and patients are typically overly optimistic with regards to expected outcomes following surgery. Published data on clinical and functional outcomes show that persistence of symptoms, such as pain, and failure to return to preoperative levels of function are normal. To measure patient's expectations we undertook prospective study reviewing patients' expectations in 1800 THRs over a 21-year period (1997–2018). Of the whole cohort, 48.98% patients reported they wanted a THR to overcome unbearable pain. 11.75 % wanted a THR to be able to walk without a limp. 9.69% wanted to a THR to increase walk endurance. 61.97% reported it was extremely important to decrease pain following a THR. In 2001, the most important reason for a THR reported by patients was to relieve unbearable pain and this remained the same most important reason in 2018. This result was also statistically significant with a p-value of 0.001. 80.36% reported they anticipated ‘no pain’ after recovery from a THR, 16.75% reported they anticipated ‘some pain’ and 2.89% reported they anticipated ‘extreme pain’ following a THR. 74.71% reported it was extremely important to increase their ability to undertake normal activities. 22.06% reported it was very important, 2.40% reported it was moderately important, 0.55% slightly important and 0.28% reported it was not all to important to increase their ability to undertake normal activity. In conclusion patients' want to reduce their pain, walk normally and increase their level activities. Differences in expectation fulfilment may be due to unrealistic expectations. To achieve optimal outcome managing patient expectations is vital

Patient expectations and their fulfilment are an important factor in determining patient-reported outcome and satisfaction of hip (THR) and knee replacement (TKR). The aim of this prospective cohort study was to examine the expectations of patients undergoing THR and TKR, and to identify differences in expectations, predictors of high expectations and the relationship between the fulfilment of expectations and patient-reported outcome measures. During the study period, patients who underwent 346 THRs and 323 TKRs completed an expectation questionnaire, Oxford score and Short-Form 12 (SF-12) score pre-operatively. At one year post-operatively, the Oxford score, SF-12, patient satisfaction and expectation fulfilment were assessed. Univariable and multivariable analysis were performed. Improvements in mobility and daytime pain were the most important expectations in both groups. Expectation level did not differ between THR and TKR. Poor Oxford score, younger age and male gender significantly predicted high pre-operative expectations (p < 0.001). The level of pre-operative expectation was not significantly associated with the fulfilment of expectations or outcome. THR better met the expectations identified as important by patients. TKR failed to meet expectations of kneeling, squatting and stair climbing. High fulfilment of expectation in both THR and TKR was significantly predicted by young age, greater improvements in Oxford score and high pre-operative mental health scores. The fulfilment of expectations was highly correlated with satisfaction

There is a paucity of information regarding patient rated expectations of surgery and measures of satisfaction with surgery in terms of specific outcome measures such as pain. The aim of this study was to investigate patient expectations of surgery and short and long term satisfaction with the outcome of decompressive surgery in terms of pain, function, disability, general health. Eighty-four patients undergoing spinal stenosis surgery were recruited into this study. On recruitment into the study patients were also asked to rate their expectations of improved in pain, general health, function etc. In addition at each review stage patients were asked to rate their satisfaction in improvement of these key outcome measures. These demonstrated that patients had very high expectations of recovery particularly in terms of pain and function and that patients were confident of achieving this recovery (76.8%) confident of a good result. Levels of satisfaction however, varied considerably. 41% of subjects were 50% satisfied with the outcome, whilst 30% were dissatisfied. Most patients felt that they had made the right decision to have surgery although the surgery had only achieved 43.4% ± 37.8 of the outcome they had expected. Examination of patient’s expectations of and satisfaction with surgery revealed that frequently patients had unrealistic expectations of their surgery and as a consequence tended to have lower levels of satisfaction

Purpose. Patient expectations of total knee arthroplasty (TKA) can be managed through education. E-learning is the application of information technology to education. Providing information to patients at the place and time of their choosing, e-learning has the potential to broaden the reach of existing services for patients. This study evaluated whether an e-learning tool could affect whether patients felt their expectations were met and whether they were satisfied with surgery one year following primary TKA. Method. We recruited consecutive patients with osteoarthritis and randomized them to either standard patient education (n=207), or to our standard patient education plus a new e-learning tool (n=209). Preoperative measures were completed following the patients’ Pre-Admission clinic (PAC) visit and prior to accessing the e-learning tool. Postoperative patient reported outcome measures (PROMs) were completed at six weeks, three months and one year after TKA. We used the Postoperative Expectation Questionnaire to measure the degree to which patient expectations had been met and the Patient Acceptable Symptom State (PASS) question to measure patient satisfaction at one year postoperative. We collected several PROMs for descriptive purposes including: new Knee Society Knee Scoring System (KSS); (Pre-Op and Post-Op versions), Knee injury and Osteoarthritis Outcome Score (KOOS), the Medical Outcomes Study 12-Item Short Form Health Survey, version 2 (SF-12), Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), University of California at Los Angeles (UCLA) Activity Score, and the Social Role Participation Questionnaire (SRPQ). Results. Both groups were similar with respect to their preoperative PROMs. Preoperative patient satisfaction was low, with few patients satisfied with their present state prior to TKA and similar between groups (14% intervention group, 11% control group). At one year postoperatively, the risk that expectations of patients were not met was 21.8% in the control group and 21.4% in the intervention group for a risk difference of 1.3% (95% CI −7.8% to 10.4%, p = 0.78). The proportion of patients satisfied with their TKA at one year postoperative was similar in the intervention group 78.6% and the control group 78.2%, and the risk difference 0.6% (95% CI −8.4% to 9.6%) was not statistically significant (p = 0.78). At one year postoperative we found significant postoperative between-group differences in favour of the control group for the new KSS symptoms score and the functional activities score. We also found that control patients had less anxiety, lower scores for rumination, magnification, and helplessness than intervention patients on the PCS. Conclusion. Patients randomized to the e-learning tool had significantly better KSS symptom scores and functional activities scores as well as lower anxiety and helplessness scores but they did not have a reduced risk of expectations not being met or an improved overall satisfaction with their TKA

Purpose: Purpose of this study was to evaluate the results of elective lumbar spinal surgery as it relates to patient expectations for outcome and outcome as quantified by patient derived generic and disease specific measures. Methods: Prospectively collected patient derived generic health status (SF-36) and disease specific outcome measures (Oswestry) were quantified in all patients prior to surgery, and at serial postoperative clinical follow-ups. Patient expectations for their surgery were also measured; (pain relief, sleep, recreational and daily activities of living, return to work). Postoperatively, patients completed a questionnaire regarding the results of their spinal surgery as it related to meeting their expectations. Multivariate analysis of variance was used to evaluate for factors that influenced the results of surgery relating to patient expectations. Results: Between 1998 and 2002 one hundred and forty three consecutive patients were evaluated. Average age was 52 (range 18–84). Diagnosis was disc herniation 43%, spondylitic spondylolisthesis 10%, degenerative spondylolisthesis 30%, spondylosis 6%, other 11%. The mean preoperative SF-36 mental component and physical component scores were 42.1 and 22.3 respectively (1.2 and 3.4 standard deviations below age and gender matched norms). Postoperative SF-36 scores were 48.1 and 38.6. The mean Oswestry disability scores were 48.7% preoperatively vs. 23.1% postoperatively. 81% (116/143) had their expectations met. Of the 19% (27 patients) who did not meet their expectations, they reported lower preoperative SF-36 general health and vitality domain scores. Patients were also less likely to have their expectations met if they had prior lumbar surgery, were involved in worker compensation or litigation. Patients who reported either back or back > leg symptoms were less satisfied than patients who presented with predominantly leg symptoms. Conclusions: Patient factors inclusive of mental, (as measured by general health perception and vitality), physical (predominance of leg vs back pain), and social (presence of compensation, litigation), all contribute to patient satisfaction and outcomes following lumbar spinal surgery for degenerative conditions

Patient expectations and their fulfilment are an important factor in determining patient-reported outcome and satisfaction of hip (THR) and knee replacement (TKR). The aim of this prospective cohort study was to examine the expectations of patients undergoing THR and TKR, and to identify differences in expectations, predictors of high expectations and the relationship between the fulfilment of expectations and patient-reported outcome measures. During the study period, patients who underwent 346 THRs and 323 TKRs completed an expectation questionnaire, Oxford score and Short-Form 12 (SF-12) score pre-operatively. At one year post-operatively, the Oxford score, SF-12, patient satisfaction and expectation fulfilment were assessed. Univariable and multivariable analysis were performed. Improvements in mobility and daytime pain were the most important expectations in both groups. Expectation level did not differ between THR and TKR. Poor Oxford score, younger age and male gender significantly predicted high pre-operative expectations (p < 0.001). The level of pre-operative expectation was not significantly associated with the fulfilment of expectations or outcome. THR better met the expectations identified as important by patients. TKR failed to meet expectations of kneeling, squatting and stair climbing. High fulfilment of expectation in both THR and TKR was significantly predicted by young age, greater improvements in Oxford score and high pre-operative mental health scores. The fulfilment of expectations was highly correlated with satisfaction

Introduction. Despite the demonstrated success of total knee arthroplasty (TKA) and higher rates of arthritis and disability from arthritis among minorities, these populations utilize TKA at lower rates than non-Hispanic white patients in the United States. In addition, women present for TKA with more advanced disease prior to TKA than their male counterparts. In order to explore potential reasons for this, we examined the relationship between race, gender, and pre-operative expectations on postoperative outcomes among patients undergoing TKA. Methods. 134 patients scheduled for primary unilateral TKA secondary to moderate to severe osteoarthritis were enrolled in this two-institution prospective study. All patient demographics were collected and recorded in an electronic data registry. In addition, patient reported outcome (PRO) questionnaires, including the Knee Injury and Osteoarthritis Outcome Score (KOOS), HSS Patient Expectation Questionnaire, Social Support Survey, Pain Catastrophizing Scale, Visual Analogue Pain Scale (VAS), Geriatric Depression Scale and European Quality (EQ) of Life 5-Dimensions with EQ VAS were prospectively collected at 4 time points (baseline, 4–8 weeks, 9–14 months, 20–26 months postoperative). Statistical analysis was then conducted among patients of different gender and ethnic background to assess for the effect of these demographic variables on patient expectations and outcomes. Results. Female sex was associated with worse preoperative KOOS scores in symptoms (p=0.021), pain (p=0.019), and activities of daily living (p=0.020). African American race was associated with worse preoperative KOOS scores in pain (p=0.009), activities of daily living (ADLs) (p=0.004), and quality of life (QOL) (p=0.003). However, despite worse pre-operative scores, no statistically significant differences were noted in the aforementioned categories between the groups at any point post-operatively. Conclusion. Our results indicate that female and African American patients undergoing TKA presented with worse pre-operative KOOS scores compared with white male patients. However, outcomes were good among all groups postoperatively, and neither race nor gender was associated with compromised post-operative outcomes in relation to pain, ADLs or QOL. These findings may be valuable in counseling patients and surgeons regarding the value of increase utilization of TKA in these patient populations. Further study is necessary to better understand the lower utilization or later presentation observed in these populations

There is increasing knowledge regarding the functional outcome of patients following posterior lumbar spinal surgery for degenerative conditions of the spine. There is less known regarding the expectations patients have for spinal surgery and how that may relate to commonly reported surgical outcome measures. It was the purpose of this study to evaluate the results of elective lumbar spinal surgery as it relates to patient expectations for outcome. and outcome as quantified by both physician reported outcome and patient derived generic and disease-specific measures. Patient expectations for surgery were evaluated in one hundred and fifty-five consecutive patients undergoing posterior lumbar surgery for degenerative conditions (single institution, two surgeons). SF-36+Oswestry disability was quantified preoperatively, and serially postoperatively. Preoperative expectations (pain relief, sleep, recreational, ADL, work return) were documented and postoperative expectations quantified at time of anticipated maximal medical improvement (6mos decompressions,1yr with fusions). Mean preoperative SF-36 MCS and PCS scores were 3.4 and 1.2 S.D. below age/gender matched Canadian norms. Although patients reported improvements in SF-36+Oswestry scores following surgery, mean SF-36 MCS and PCS scores were still 2 and 1.5 S.D. below norms. Mean Oswestry disability improved from 48.7%±1.7% to 23.1±1.9%. Expectations for surgery were met in 81%(responders:143/155). Of 19%(27/143) where expectations were not met, 6/27 have either nonunion, technical, or medical factors. There was no difference in mean age, gender, comorbidity, procedure type and follow-up comparing patients where expectations were met to those that were not. Patients where expectations were not met reported lower preoperative SF-36 (GH and VT) domain scores (p=0.02 and 0.04, respectively), however, preoperative Oswestry, SF-36 MCS and PCS scores were not significantly different. Patients were less satisfied if they had prior lumbar surgery (p=0.02) or involved in WCB/litigation (p< 0.001). We note 15%(21/143) where expectations were not met and there were no apparent surgical or medical confounds to account. There are likely other factors that may influence patient perception and expectation for treatment which requires further study

We aimed to document the pre-operative expectations in Korean patients undergoing total knee replacement using an established survey form and to determine whether expectations were influenced by sociodemographic factors or pre-operative functional status. Expectations regarding 17 items in the Knee Replacement Expectation Survey form were investigated in 454 patients scheduled for total knee replacement. The levels and distribution patterns of summated expectation and of five expectation categories (relief from pain, baseline activity, high flexion activity, social activity and psychological well-being) constructed from the 17 items were assessed. Univariate analyses and multivariate logistic regression were performed to examine the associations of expectations with the sociodemographic factors and the functional status.

The top three expectations were relief from pain, restoration of walking ability, and psychological well-being. Of the five expectation categories, relief from pain was ranked the highest, followed by psychological well-being, restoration of baseline activity, ability to perform high flexion activities and ability to participate in social activities. An age of < 65 years, being employed, a high Western Ontario and McMaster Universities osteoarthritis index function score and a low Short-form 36 social score were found to be significantly associated with higher overall expectations.

The burden of metastatic bone disease (MBD) in our Canadian cancer population continues to increase. MBD has a significant effect on patient morbidity, mortality, and health-related quality of life (HRQOL). There are various technical options used to surgically stabilize MBD lesions, surgical decision-making is variable and largely dependent on anatomic and surgeon-based factors. There is a paucity of research examining how surgical decision-making for MBD can be modified or individualized to improve quality of life (QOL) and functional outcomes, while more accurately aligning with patient-reported goals and expectations. The objective of this study was tosurvey MBD patients, support persons, physicians, and allied health care providers (HCP) with the goal of identifying 1) important contributors to HRQOL, 2) discordance in peri-operative expectations, and 3) perceived measures of success in the surgical management of MBD.

This project is a longitudinal patient-engaged research initiative in MBD. A survey was developed based on HRQOL themes in the literature and based on feedback from our patient research partners. Participants were asked to identify 1) important contributors to HRQOL and 2) perceived measures of success relevant to the surgical management of MBD. Participants were asked to rank themes from ‘extremely important’ to ‘not important at all’. Using open-ended questions, participants were asked to identify areas of improvement. Responses from the open-ended questions were analyzed by an experienced qualitative researcher using conventional content analysis. Participant's demographics were calculated using descriptive statistics. Concordance or discordance of perceived measure of success was assessed via a Chi-Square test of independence. All statistical analyses were performed using IBM SPSS® software.

Nine patients, seven support persons, 23 orthopaedic surgeons, 11 medical oncologists, 16 radiation oncologists, 16 nurses, and eight physiotherapists completed the survey. Regarding perceived measures of success, increased life expectancy (p Two main themes emerged around the timeliness of surgical care and the coordination of multidisciplinary care from patients and support persons. Patients and support persons expressed a sense of urgency in progressing to surgery/treatment, and frustration at perceived delays in treatment. Within coordination of care, patients and support persons would like clearer communication from the health care team.

There is discordance between patient/support person goals compared to physicians/HCP goals in the surgical management of MBD. Surgical decision-making and operative techniques that minimize disease progression and improve survival are important to MBD patients. Timely access to surgery/surgical consultation and improved multidisciplinary communication is important to patients. This data suggests improved peri-operative communication and education is needed for MBD patients. Furthermore, future research evaluating how modern orthopaedic surgical techniques influence survival and disease progression in MBD is highly relevant and important to patients with MBD.

We explored the outcome of staged bilateral total knee replacement (TKR) for symmetrical degenerative joint disease and deformity in terms of patient expectations, functional outcome and satisfaction. From 2009 to 2011, 70 consecutive patients (41 female) with a mean age of 71.7 years (43 to 89) underwent 140 staged bilateral TKRs at our institution, with a mean time between operations of 7.8 months (2 to 25). Patients were assessed pre-operatively and at six and 12 months post-operatively using the Short Form-12, Oxford knee score (OKS), expectation questionnaire and satisfaction score. The pre-operative OKS was significantly worse before the first TKR (TKR1), but displayed significantly greater improvement than that observed after the second TKR (TKR2). Expectation level increased from TKR1 to TKR2 in 17% and decreased in 20%. Expectations of pain relief and stair-climbing were less before TKR2; in contrast, expectations of sporting and social activities were greater. Decreased expectations of TKR2 were significantly associated with younger age and high expectations before TKR1. Patient satisfaction was high for both TKR1 (93%) and TKR2 (87%) but did not correlate significantly within individuals. We concluded that satisfaction with one TKR does not necessarily translate to satisfaction following the second. . Cite this article: Bone Joint J 2014;96-B:752–8

The aim was to determine the knowledge patients have about Total Hip Joint Replacement, their expectations from it and to evaluate the degree of disability from their hip and co-morbidities.

A total of eighty questionnaires were posted to two groups of patients. The survey consisted of open ended questions. They were also requested to complete Hospital for Special Surgery Hip Replacement Expectation Survey. Patients awaiting a Total Hip Joint replacement were assessed using Harris Hip Score and Index for Coexistent Disease.

Response rate was 81%. Average Harris hip score of 44.96 for the group on the waiting list for THJR.16 of 29 patients fell between mild to severe ICED. Questions to ascertain patient’s knowledge of THJR its risks and complications were open ended. 32–67% either expressed being unaware or answered incorrectly to these questions. Analysis of the Expectation survey revealed that over 75%of patients in both groups rated 15 of the 18 items as being an important expectation. The three items rated low/not applicable in expectation were related to employment, sexual activity and use of support for mobilizing.

This survey reveals a population waiting for a THJR possessing inadequate and unacceptable levels of knowledge about it while having high expectations of improvement in their quality of life. Unmet expectations can form grounds for complaints and even recourse to medico legal action. The expectations of the patients waiting for a THJR should be discussed and realistic goals set.

Total hip arthroplasty (THA) has high rates of patient satisfaction; however patient expectations for recreational and sporting activities are not always met. Our study aimed to identify preoperative factors that predict whether patient expectations for sporting or recreational activity are met 12 months following THA. Patient reported outcome measures (PROMs) were collected prospectively from 2015-2018 at one private hospital in Sydney. Age, gender, postcode, weight, and height were recorded preoperatively. Included participants underwent primary THA by one of the investigating surgeons. Univariable and multivariable analyses were performed with an expectation fulfilment score used as the primary outcome variable. Preoperative predictor variables included: age, gender, BMI, Socio-economic Indexes for Areas (SEIFA), Oxford Hip Score, Hip Osteoarthritis Outcome Score, EQ-5D-5L and EQ Visual Analogue Scale (EQ VAS). 1019 participants were eligible and included. 13% reported that preoperative expectations of sport or recreation were not met at 12 months. Younger age, lower preoperative EQ VAS, and higher BMI were associated with failed expectations on multivariable analysis. Odds of failed expectations increased by 2% for every one year younger in age (OR= 0.98, 95% CI = 0.96 to 1.00, p=.048), by 2% for every one point lower on EQ VAS (OR=0.98, 95% CI = 0.98 to 0.99, p=.002), and by 4% for every one-point increase in BMI (OR = 1.04, 95% CI = 1.00 to 1.09, p=.042). Failure to have expectations met for sporting or recreational activity was associated with younger age, poorer general health, and high BMI. With a rise in younger patients who likely have higher physical demands, a tailored preoperative education is preferable to generic models to better manage patient expectations. Younger age, higher BMI, and poorer health may predict unmet expectations for sport and recreation after THA. Tailored education in these groups should be considered

The number of revision total hip arthroplasties (THA) is increasing. This procedure is associated with a higher complication rate than primary THA, and so it is important for patients to have realistic expectations. The aim of this systematic review was to gather and summarise the available evidence on patients’ expectations following revision THA. A literature search was conducted in PubMed, PsycINFO, Cochrane, Google Scholar and Web of Science from inception to December 2021. Methodological quality was assessed by two independent reviewers using the National Heart, Lung and Blood Institute (NIH) study quality assessment tool for observational cohort and cross-sectional studies. The search strategy generated 3132 references of which 4 articles met the inclusion criteria. Methodological quality scores ranged from 7–10. Patients have high expectations concerning future walking ability, pain and implant longevity. Implant longevity expectations vary according to the longevity of the primary implant. A significant positive correlation was found between fulfilled expectations of pain and walking ability and patient satisfaction (r = .46 – .47). Only one study assessed fulfilment of patient expectations. Great variability was seen in operationalisation and assessment of expectations. Patients undergoing revision THA appear to have high expectations with regards to future outcomes. Whilst results are promising, there is a paucity of high-quality data in this area. Further research is needed, which places emphasis on developing a sound theoretical framework for expectations, allowing for the consistent implementation of valid measurement tools

Purpose and background. Understanding patients’ expectations of back pain treatment can help improve their experiences, adherence and outcomes. Patients typically expect a diagnosis and exercise-based physiotherapy, but often undervalue the role of psychological factors. This study explored patients’ expectations of outpatient physiotherapy treatment for back pain in primary care. Methods and Results. The design, a secondary analysis of a qualitative cross-sectional study, involved 25 patients (13M:12F), aged 20–81, referred with low back pain (duration 7 weeks to 9 years). This sample did not include patients with serious spinal pathologies, known psychological disorders, or those unable to communicate without assistance. Face-to-face interviews were undertaken in patients’ homes, which were audio-recorded, transcribed verbatim and analysed using the six stages of thematic analysis outlined by Braun and Clarke. Patients expected a caring clinician and a strong therapeutic relationship, where they felt believed, openly communicated with and valued as an individual. Most patients expected a diagnosis and credible explanation for their pain. There was an almost equal split between those keen to take responsibility for their care and those who felt this was the clinicians’ role. Expectations of passive therapies were slightly higher in this study than existing research. Most patients were realistic about outcomes and expected treatment to reduce their pain, but not cure it. Conclusion. A positive experience mattered most to patients, valuing the relational aspects of their care more than the clinical content provided. Patients saw back pain through a biomedical lens, and most failed to recognise the role of psychosocial factors in their condition or treatment. Conflicts of interest. None. Sources of funding. Funding for primary data: Arthritis Research UK (now Versus Arthritis)

Aims. This scoping review aims to identify patient-related factors associated with a poorer outcome following total ankle arthroplasty (TAA). Methods. A scoping review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A computer-based literature search was performed in PubMed, Embase, Cochrane trials, and Web of Science. Two reviewers independently performed title/abstract and full-text screening according to predetermined selection criteria. English-language original research studies reporting patient-related factors associated with a poorer outcome following TAA were included. Outcomes were defined as patient-reported outcome measures (PROMs), perioperative complications, and failure. Results. A total of 94 studies reporting 101,552 cases of TAA in 101,177 patients were included. The most common patient-related risk factor associated with poorer outcomes were younger age (21 studies), rheumatoid arthritis (17 studies), and diabetes (16 studies). Of the studies using multivariable regression specifically, the most frequently described risk factors were younger age (12 studies), rheumatoid arthritis (eight studies), diabetes (eight studies), and high BMI (eight studies). Conclusion. When controlling for confounding factors, the most commonly reported risk factors for poor outcome are younger age, rheumatoid arthritis, and comorbidities such as diabetes and increased BMI. These patient-related risk factors reported may be used to facilitate the refinement of patient selection criteria for TAA and inform patient expectations. Cite this article: Bone Joint J 2023;105-B(9):985–992

Abstract. Introduction. Recent research has questioned the role of arthroscopic meniscectomy in patients with a meniscal tear leading to the development of treatment recommendations for these patients. There is a clear need to understand patient perceptions of living with a meniscal tear in order to plan future research and treatment guidelines. Aims. To explore the experiences and expectations of treatment of young patients with a meniscal tear of the knee. Methodology. Ten participants diagnosed with a meniscal tear were recruited from the METRO cohort study using a purposive sampling strategy. These patients underwent semi-sructured interviews between April and May 2021. Thematic analysis was used to code the transcripts and generate key themes in order to describe the data. Results. Themes identified relate to the broad areas of: the effect of symptoms, the expericne of the clinical consultation and the experience of the treatment modality undertaken. Meniscal tears have a profound impact on pain and many patients experience effects on their family and financial life in addition to physical symptoms. Participants expected the majority of their management to occur in secondary care and most thought surgery would be a definitive treatment, while the effectiveness of physiotherapy could not be guaranteed as it would not fix the physical tear. Conclusion. Patient experience of meniscal tear may not correspond with current available clinical evidence. Clinicians should consider the common misconceptions highlighted in this study when conducting a consultation and pre-empt them to optimally manage patient expectations

Purpose. To explore the relationship in terms of time scale between pre-operative expectations and postoperative outcomes and satisfaction after Hallux valgus surgery. Methods. A patient derived questionnaire was developed and 30 patients aged 19 to 67 were included undergoing primary hallux valgus correction with a first metatarsal osteotomy and distal soft tissue release. Patients were asked pre-operatively to quantify their expected time scale for improvement in pain, ability to walk unaided, ability to drive, routine foot wear and foot feeling normal at 6 weeks, 3 and 6 months following surgery, and to indicate their confidence in achieving this result. Patients recorded postoperative outcomes achieved at number of weeks. Ordinal logistic regression multivariate modelling was used to examine predictors of postoperative satisfaction. Results. 90% of the patients were able to walk unaided and drive before or around the expected time scale at an average of five weeks' time. Persistent pain subsided at an average of two weeks post operatively which led to high satisfaction Although differences between patients' expectation and achievement were minimal at 6 weeks post-operatively, there was some discrepancy at 3 months, with patient expectations far exceeding achievement. The least satisfactory outcome was normal feeling of foot at six months follow up. There were significant correlations between failure to achieve expectations and the importance patients attached to recovery. Conclusions. This study underlines the importance of taking preoperative expectations into account to obtain an informed choice on the basis of the patient's preferences. Patients' pre-operative expectations of surgical outcome exceed their functional achievement but satisfaction remains high if pain control and ability to walk unaided is achieved early after hallux valgus corrective surgery

Purpose and background of the study. Self-management and behaviour change is at the core of back pain management. Despite the high-rate of recurrence and healthcare utilisation, clinical guidelines do not include guidance for clinicians on return consultations. This project aimed to identify primary care clinicians’ reported practices and experiences of delivering self-management advice for people returning with persistent low back pain (LBP), to inform future delivery of self-management care. Methods and Results. In this qualitative study involving 27 primary care clinicians, four focus groups and two semi-structure interviews were conducted online. GPs (n=5) and physiotherapists working in primary care roles (First contact practitioners n=7, community and interface roles n=7, and mixed roles n=8) in England and Scotland shared their experience of delivering self-management advice to people returning with persistent LBP. Video recordings were transcribed verbatim and analysed with reflexive thematic analysis. Clinicians unanimously shared their frustrations identifying the challenges involved in supporting people who return with LBP. Helpful strategies to support self-management in return consultations were identified by clinicians in addition to service and system-level changes vital to optimise care. Patient-factors affecting delivery of care, lack of defined responsibility and challenges in meeting patients’ expectations illustrated the tensions that exist in return consultations. Conclusion. This novel study provides insight into the experiences and practices of the frontline primary care workforce seeing patients return with persistent or recurrent LBP. It identifies the tensions that exist between services, professional roles and between clinicians and patients regarding self-management. Important practice implications have been identified to improve information-sharing, agenda-setting, and exploring expectations. No conflicts of interest.  . Source of funding. Lisa Osborn-Jenkins is funded by University Hospital Southampton NHS Foundation Trust (UHS) Research & Development PhD Fellowship [GRT0723]

Total knee replacement (TKR) design aims to restore normal kinematics with emphasis on flexion range. The survivorship of a TKR is dependent on the kinematics in six-degrees-of-freedom (6-DoF). Stepping up, such as stair ascent is a kinematically demanding activity after TKR. The debate about design choice has not yet been informed by 6-DoF in vivo kinematics. This prospective randomised controlled trial (RCT) compared kneeling kinematics in three TKR designs. 68 participants were randomised to receive either cruciate retaining (CR-FB), rotating platform (CR-RP) or posterior stabilised (PS-FB) prostheses. Image quality was sufficient for 49 of these patients to be included in the final analysis following a minimum 1-year follow-up. Patients completed a step-up task while being imaged using single-plane fluoroscopy. Femoral and tibial computer-aided design (CAD) models for each of the TKR designs were registered to the fluoroscopic images using bespoke software OrthoVis to generate six-degree-of-freedom kinematics. Differences in kinematics between designs were compared as a function of flexion. There were no differences in terminal extension between the groups. The CR-FB was further posterior and the CR-RP was more externally rotated at terminal extension compared to the other designs. Furthermore, the CR-FB designs was more posteriorly positioned at each flexion angle compared to both other designs. Additionally, the CR-RP design had more external femoral rotation throughout flexion when compared with both fixed bearing designs. However, there were no differences in total rotation for either step-up or down. Visually, it appears there was substantial variability between participants in each group, indicating unique patient-specific movement patterns. While use of a specific implant design does influence some kinematic parameters, the overall patterns are similar. Furthermore, there is high variability indicating patient-specific kinematic patterns. At a group level, none of these designs appear to provide markedly different step-up kinematic patterns. This is important for patient expectations following surgery. Future work should aim to better understand the unique patient variability