Understanding Patient Expectations and Outcomes After Total Knee Arthroplasty: A Cross-Sectional Indian Study.

Abstract

Total knee arthroplasty (TKA) is a well-established treatment for advanced knee osteoarthritis. While it offers major pain relief and functional improvement, patient satisfaction often depends on how well postoperative outcomes align with preoperative expectations. In culturally diverse settings like India, specific activities such as squatting and sitting cross-legged may influence patient perceptions of success. This study aimed to evaluate the expectations of Indian patients undergoing TKA and assess their fulfillment after one year. A cross-sectional observational study was conducted at a tertiary care center in North India from January 2021 to December 2023. There were 300 patients aged ≥ 50 years who had primary osteoarthritis who underwent unilateral or bilateral TKA using either posterior-stabilized (PS) or cruciate-retaining (CR) implants were included. All patients completed one year of follow-up. Preoperative expectations were assessed using a modified Hospital for Special Surgery (HSS) Expectation Survey. Postoperative outcomes were evaluated using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS) for pain, and a five-point Likert scale for satisfaction. Pain relief (91%), walking (85%), and daily household activities (82%) were the most commonly fulfilled expectations. Expectations for squatting and sitting cross-legged were met in only 36 and 29% of patients, respectively. Overall, 80% of patients reported being satisfied or very satisfied. Fulfillment of expectations related to pain and ambulation showed a significant positive association with higher satisfaction (P < 0.05). There was no significant difference observed between CR and PS implant recipients. While core functional goals are largely met, cultural expectations often remain unfulfilled after TKA in Indian patients. Preoperative counseling that addresses realistic goals may enhance satisfaction and patient-centered care.