Total Hip Arthroplasty: The Influence of Different Management Structures in Germany and the Netherlands on Preoperative Expectations, Self-Efficacy, and Postoperative Satisfaction.

Objective Total hip arthroplasty (THA) is considered a highly effective treatment for end-stage hip osteoarthritis (OA). THA management in Germany and the Netherlands significantly differs. This study aims to give a first glimpse of the extent to which the way of management in both countries influences patients' preoperative expectations, self-efficacy, and, consequently, their postoperative satisfaction.  Methods This was a transnational, prospective, multicenter observational study that included a cohort of primary THA patients from Germany and the Netherlands. Preoperatively, patients completed the Hospital for Special Surgery Hip Replacement Expectations Survey (HSS-HRES), Self-Efficacy of Rehabilitation questionnaire (SER), and the Hip disability and Osteoarthritis Outcome Score (HOOS). Postoperatively, patients rated their satisfaction on a Likert scale (0-10). Scores of German and Dutch patients were compared using student t-tests and Chi-square tests. Simple and multiple regression analyses were used to assess the relationship between preoperative expectations and self-efficacy on postoperative satisfaction with country as the categorical variable. Results A total of 138 German and 152 Dutch participants were included. German patients showed significantly higher levels of preoperative expectations and self-efficacy. In the simple regression analysis, preoperative self-efficacy showed a statistically significant relationship with postoperative satisfaction (SER: B 0.129 (95%CI 0.004 - 0.255), p=.044). In the multiple regression analysis, preoperative HOOS Sport and HOOS QOL (Quality Of Life) showed a statistically significant relationship with postoperative satisfaction (HOOS Sport: B -0.020 (95%CI -0.040 to -.001), p=.042; HOOS QOL: B 0.025 (95%CI 0.002-0.048), p=.034). The country had no influence. Conclusion There is a difference in preoperative expectations and self-efficacy between German and Dutch patients. Moreover, preoperative self-efficacy influences postoperative satisfaction. However, this effect disappeared in the multiple regression analysis, nor was the country of treatment influential. On the other hand, we do see that higher preoperative scores on HOOS Sports and HOOS QOL lead to higher postoperative satisfaction.