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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

4 Issues per year

CiteScore 2017: 0.84

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Volume 18, Issue 3

Patients’ pre-operative general and specific outcome expectations predict postoperative pain and function after total knee and total hip arthroplasties

Claire Tilbury / Tsjitske M. Haanstra
  • Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Suzan H.M. Verdegaal / Rob G.H.H. Nelissen / Henrica C.W. de Vet
  • Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Thea P.M. Vliet Vlieland / Raymond W. Ostelo
  • Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
  • Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2018-04-30 | DOI: https://doi.org/10.1515/sjpain-2018-0022


Background and aims

Previous studies have suggested there is an association between preoperative expectations about the outcome and outcomes of total knee and total hip arthroplasty (TKA/THA). However, expectations have been rarely examined on their clinical relevance relative to other well-known predictive factors. Furthermore expectations can be measured on a more generic level (e.g. does one expect their symptoms to improve after surgery) or on a more specific level (e.g. does one expect to be able to squat again after surgery). Aim of this study was to examine whether patients’ general and specific preoperative outcome expectations predict function and pain 12-months after TKA/THA, when assessed as one of the candidate predictive variables alongside other relevant clinical and sociodemographic variables. Moreover, we explored whether a more generic or a more specific assessment of expectations would better predict outcome.


A prospective cohort study on consecutive TKA/THA patients, with assessments done preoperatively and 12-months postoperative. Primary outcomes were the knee injury and osteoarthritis outcome score (KOOS) and hip injury and osteoarthritis outcome score (HOOS) activities of daily living (ADL) and pain subscale scores at 12-months. The pain subscales consist of nine-(KOOS) and 10-(HOOS) items and the ADL of 17 items. Patients’ preoperative outcome expectations were measured with the credibility expectancy questionnaire (CEQ), which contains three items scored on a 0–9 scale and sum score 0–27 and the Hospital for Special Surgery expectations surveys (HSS expectation surveys) for 17(TKA) or 18(THA) outcomes on 0–4 scale. Other candidate predictors: preoperative pain and function as measured with HOOS/KOOS, sex, age, education level, body mass index, Kellgren/Lawrence score, preoperative mental health and treatment credibility as measured with CEQ. Eight prediction models were constructed using multivariate linear regression analysis with a backward selection procedure.


The 146 TKA patients included in this study had a mean age of 66.9 years (SD 9.2) and 69% was female. The 148 THA patients had a mean age 67.2 (SD 9.5) and 57% was female. Mean outcomes: postoperative HOOS-ADL 84.3 (SD 16.6), pain 88.2 (SD 15.4), KOOS-ADL 83.9 (SD 15.8) and pain 83.6 (SD 17.1). CEQ-expectancy median was in THA 23 (IQR 21;24) and TKA 23 (IQR 20;24). HSS-expectation surveys function was for THA 21.0 (18.0;24.0) and 19.0 (14.0;22.0) in TKA. Patients’ outcome expectations were consistently part of the combination of variables that best predicted outcomes for both TKA/THA 1-year post-operatively. Expectations alone explained between 17.0 and 30.3% of the variance in outcomes. The CEQ expectancy subscale explained more variance of postoperative function in TKA and of function and pain in THA as compared to the HSS expectation surveys.


In planning of surgical treatment, orthopedic surgeons should take a range of variables into account of which the patient’s expectations about outcome of surgery is one. The CEQ expectancy subscale predicted outcomes slightly better as the HSS expectation surveys, but differences in predictive value of the two measurements were too small to prefer between the two. Future studies are advised to replicate these findings and externally validate the models presented.

Keywords: outcome; expectations; total hip arthroplasty; total knee arthroplasty; osteoarthritis; function; pain


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About the article

Received: 2018-01-23

Revised: 2018-04-09

Accepted: 2018-04-09

Published Online: 2018-04-30

Published in Print: 2018-07-26

Authors’ statements

Research funding: No research funding was obtained for this study.

Conflict of interest: None of the authors has any potential financial conflict of interest related to this manuscript.

Informed consent: Written informed consent to participate in the study was obtained from all patients.

Ethical approval: The study protocol was reviewed and approved by the local hospital review board (Rijnland Hospital, Leiderdorp; registration number 10/07), which is affiliated to the Medical Research Ethics Committee of Leiden University Medical Center, Leiden, the Netherlands.

Citation Information: Scandinavian Journal of Pain, Volume 18, Issue 3, Pages 457–466, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2018-0022.

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