The preoperative education on realistic expectations does not continually improve patients' satisfaction after total knee arthroplasty? A randomized controlled trial with serial assessment.

Abstract

This study aimed to determine whether preoperative education using an additional module based on realistic expectations continuously improves patient satisfaction after total knee arthroplasty (TKA), particularly in highly centrally sensitized patients. This was a single-center, randomized controlled trial. Initially, 172 patients who underwent TKA were enroled. The patients were randomly assigned to the intervention (additional module on realistic expectations) or control (standard preoperative education) groups. Prospective serial assessments were conducted at postoperative 3-months, 6-months, 1-year and 2-years. The primary outcome was patient satisfaction, and the secondary outcomes were Short Form (SF)-36 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Subgroup analysis was performed using central sensitization inventory (CSI) scores. At 1-year, the mean satisfaction score was higher in the intervention group than in the control group (4.2 ± 0.9 vs. 3.9 ± 0.9, p = 0.01); however, it was not different at 2-years. Significant differences were noted in the SF-36 physical and mental (p = 0.02 and p = 0.02, respectively) and WOMAC pain and stiffness at 6-months (p = 0.04 and p = 0.04, respectively). At 1-year, a significant difference was noted in WOMAC pain (p = 0.05); however, no difference was noted at 2-years. The satisfaction score in the top 25% CSI group at 1-year was 4.6 ± 0.6 in the intervention group and 3.8 ± 0.8 in the control group (p = 0.01). However, preoperative CSI did not affect satisfaction and clinical scores at 2 years. Preoperative education on realistic expectations after TKA showed effects on secondary outcomes at postoperative 6-months, with the effect on WOMAC pain persisting at postoperative 1-year. However, the effect on patient satisfaction only appeared at 1-year postoperatively. Differences between the preoperative CSI groups were observed up to postoperative 1-year but not at postoperative 2-years. Level I.