The influence of expectation modification in knee arthroplasty on satisfaction of patients: A randomized controlled trial: The EKSPECT study

Jaap J. Tolk (Corresponding author), Rob P.A. Janssen, Tsjitske M. Haanstra, M.C. van der Steen, Sita M.A. Bierma-Zeinstra, Max Reijman

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28 Citations (Scopus)


Meeting preoperative expectations is known to be of major influence on postoperative satisfaction after total knee arthroplasty (TKA). Improved management of expectation, resulting in more realistic expectations can potentially lead to higher postoperative satisfaction. The objective of this study was to assess the effect of an additional preoperative education module, addressing realistic expectations for long-term functional recovery, on postoperative satisfaction and expectation fulfilment.

In total, 204 primary TKA patients with osteoarthritis were enrolled in this randomized controlled trial (RCT). Patients were allocated to either usual preoperative education (control group) or usual education plus an additional module on realistic expectations (intervention group). Primary outcome was being very satisfied (numerical rating scale for satisfaction ≥ 8) with the treatment result at 12 months' follow-up. Other outcomes were change in preoperative expectations and postoperative expectation fulfilment.

A total of 187 patients (91.7%) were available for analysis at follow-up. In the intention-to-treat analysis, 58.5% (55/94) of patients were very satisfied with the treatment result in the control group, and 69.9% (65/93) of patients in the intervention group (adjusted odds ratio (AOR) 1.72, 95% confidence interval (CI) 0.90 to 3.29). A per-protocol analysis for patients who attended the education session (92.0%, n = 172) showed that 56.9% (49/86) of patients were very satisfied in the control group and 74.4% (61/86) in the intervention group (AOR 2.44, 95% CI 1.21 to 4.91). After preoperative education, the expectation scores in the intervention group were significantly lower (mean difference -6.9 (95% CI -10.2 to -3.6)) and did not alter in the control group (mean difference 0.5 (95% CI -2.9 to 3.9)). Overall, fulfilment of expectations at 12 months was significantly higher in the intervention group (mean difference 11.4% (95% CI 2.3 to 20.5)).

Improved preoperative patient education can modify patient expectations, resulting in higher postoperative fulfilment of expectation and higher satisfaction in the group that attended the preoperative education. This is the first RCT to confirm the potential of improved expectation management on satisfaction after TKA.
Original languageEnglish
Pages (from-to)619-626
Number of pages8
JournalThe Bone & Joint Journal
Issue number4
Publication statusPublished - 1 Apr 2021


  • Expectation management
  • Knee osteoarthritis
  • Outcome expectations
  • Satisfaction
  • Total knee arthroplasty
  • Osteoarthritis, Knee/surgery
  • Humans
  • Male
  • Recovery of Function
  • Patient Satisfaction
  • Arthroplasty, Replacement, Knee/methods
  • Female
  • Aged
  • Patient Education as Topic


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