Mancuso Carol A, Jout Jennifer, Salvati Eduardo A, Sculco Thomas P
Hospital for Special Surgery, New York, NY 10021, USA.
J Bone Joint Surg Am. 2009 Sep;91(9):2073-8. doi: 10.2106/JBJS.H.01802.
Fulfillment of patient expectations is an important outcome of total hip arthroplasty. The objective of the present study was to determine the proportion of expectations that were fulfilled following total hip arthroplasty as well as how the fulfillment of expectations relates to patient and clinical characteristics.
Preoperatively, patients completed the Hospital for Special Surgery Hip Replacement Expectations Survey, measuring physical and psychological expectations, and the American Academy of Orthopaedic Surgeons Lower Limb Core Scale, measuring symptoms and function. Approximately four years after surgery, patients were interviewed by telephone and were asked whether each expectation that they had cited preoperatively had been fulfilled.
Four hundred and five patients were interviewed. The mean age of the patients was sixty-six years, and 58% of the patients were women. Forty-three percent of the patients reported that all of their expectations had been fulfilled completely. For the entire sample, the mean proportion of expectations that had been fulfilled completely was 87%. Patients who were younger, who were employed, who had a body mass index of <35 kg/m(2), who did not have complications, who did not have a postoperative limp, and who had better preoperative and postoperative Lower Limb Core scores had a greater proportion of expectations fulfilled (p <or= 0.05).
A better postoperative Lower Limb Core score was most closely associated with the fulfillment of expectations following total hip arthroplasty. Not having a postoperative limp was independent of the postoperative Lower Limb Core score, indicating that the impact of a limp is greater than its manifestation as a physical disability. Better preoperative status also was an independent predictor, indicating that patient expectations are more likely to be fulfilled if the patient is not the most severely impaired at the time of surgery.
满足患者期望是全髋关节置换术的一项重要结果。本研究的目的是确定全髋关节置换术后期望得到满足的比例，以及期望的满足与患者和临床特征之间的关系。
术前，患者完成特种外科医院髋关节置换期望调查问卷，以测量身体和心理期望，以及美国矫形外科医师学会下肢核心量表，以测量症状和功能。术后约四年，通过电话对患者进行访谈，询问他们术前提出的每项期望是否得到满足。
对405名患者进行了访谈。患者的平均年龄为66岁，58%为女性。43%的患者报告称他们所有的期望都已完全实现。对于整个样本，期望完全实现的平均比例为87%。年龄较小、有工作、体重指数<35 kg/m²、无并发症、无术后跛行且术前和术后下肢核心量表得分较高的患者，期望得到满足的比例更高（p≤0.05）。
术后更好的下肢核心量表得分与全髋关节置换术后期望的满足最为密切相关。无术后跛行与术后下肢核心量表得分无关，这表明跛行的影响大于其作为身体残疾的表现。更好的术前状态也是一个独立的预测因素，这表明如果患者在手术时不是受损最严重的，其期望更有可能得到满足。
