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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_12 | Pages 64 - 64
1 Oct 2018
MacDonald SJ Culliton SE Bryant D Hibbert K Chesworth BM
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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).


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 24 - 24
1 Mar 2010
Bourne RB Chesworth BM Davis AM Charron KDJ
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Purpose: The purpose of this study was to determine the reasons for patient dissatisfaction after primary TKA.

Method: Primary TKA patients (n=2513) entered into the Ontario Joint Replacement Registry (OJRR) with decision date and one year follow-up data (WOMAC, expectations, satisfaction and willingness to undergo surgery) were analyzed to determine the factors that might be associated with patients who were not satisfied with their total knee replacement.

Results: The majority of patients were satisfied with their TKA (n=1939, 81%), but 169 (7%) were uncertain and 281 (12%) were not satisfied. Pre-operative expectations were important as 89% of patients who did not have their expectations met and 40% who had no expectations were dissatisfied with their TKA. Factors that affected patient satisfaction for their TKA, controlling for age, comorbidity and post-operative complications were better pre-operative WOMAC function scores (p25 point improvement).

Conclusion: In this province-wide study, one in five TKA patients were not satisfied with their surgery at one-year follow-up. It is important that patients, surgeons and healthcare payers recognize significant factors that can lead to patient dissatisfaction and help patients establish realistic expectations prior to undergoing TKA surgery.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 229 - 229
1 May 2009
Bourne RB Anderson CK Chesworth BM Hornick LE Zaric GS
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The purpose of this study was to establish a model to predict the future need for total hip and knee replacement surgery over the next ten years.

Analysis based on queuing theory and Ontario data (Ontario Joint Replacement Registry) considered such factors as changing demographics, specific wait time objectives and changing indicators to predict the future need for THR and TKR up to 2015.

26 725 Ontarians were waiting for THR and TKR surgery on any given day in 2004–05. Each month, the number of new decisions for surgery exceeded the actual number of surgeries by over 20%, adding another five hundred patients to the wait list. We predict that the population > fifty-five years of age will increase by 3.4% annually and that the willingness of patients to consider TJR surgery will increase by 8.7%/year To reduce wait times and establish a steady state of waiting (less than 6 months wait), more than 50 000 surgeries per year must be provided within five years and 70 000 total joint replacements per year by 2014–15 as compared to the 31 448 performed annually at this time. Providing this volume of surgeries means that the number of surgeons will have to double within five to seven years.

The results of this queuing theory analysis predict a substantial need for markedly increased THR and TKR volumes and orthopaedic manpower over the next decade.