Patient expectations and satisfaction 6 and 12 months following total hip and knee replacement

  • Barbara L. Conner-SpadyEmail author
  • Eric Bohm
  • Lynda Loucks
  • Michael J. Dunbar
  • Deborah A. Marshall
  • Tom W. Noseworthy



To assess (1) patient expectations before total hip (THR) and knee (TKR) replacement; (2) which expectations are met and unmet 6 and 12 months post-surgery; (3) the role of unmet expectations in satisfaction.


Questionnaires were mailed to consecutive patients following surgeon referral for primary THR or TKR. Patients listed their own expectations and also completed the Hospital for Special Surgery (HSS) Expectation Survey. We used content analysis to group expectations into themes. At 6 and 12 months post-surgery, patients were given a copy of their own list of individual expectations and reassessed each one as met or unmet. We also assessed fulfilled HSS expectations and satisfaction with surgery.


The sample of 556 patients (49% THR, 57% female) had a mean age of 64 years (SD10). The five most frequent expectation themes were pain relief, mobility, walking, physical activities, and daily activities. Of these, physical activities had the lowest percentage met 12 months post-surgery. 95% (THR) and 87% (TKR) were satisfied/very satisfied with their surgery 12 months post-surgery. Very satisfied patients had a significantly greater percentage of met expectations (96% THR; 92% TKR) than dissatisfied patients (42% THR; 12% TKR). Although most expectations listed by patients were included in the HSS surveys, some were not, particularly for TKR. From 6 to 12 months, there was a significant increase in patient satisfaction for self-care, daily activities, and met expectations for THR and pain relief, self-care, daily activities, and recreational activities for TKR.


Expectations should be explicitly addressed before surgery, including a discussion of realistic expectations, particularly for physical activities.


Patient satisfaction Arthroplasty, replacement, knee Arthroplasty, replacement, hip Osteoarthritis Prospective studies Outcome assessment (Health care) 



We thank the research personnel who were responsible for project management and data collection: Sarah Tran, Allan Hennigar, Ammar Al Khudairy, Michaela Wallace, Kelsey Ritter, and Matthew Kivell.


This study was funded by Canadian Institutes of Health Research (CIHR) (Grant #ETG92252) and Alberta Innovates-Health Solutions (Grant # 200700596).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethics approval was obtained from the University of Manitoba Health Research Ethics Board, the Nova Scotia Health Authority Research Ethics Board, and the University of Calgary Conjoint Health Research Ethics Board. All procedures performed were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Authors and Affiliations

  1. 1.Department of Community Health SciencesUniversity of CalgaryCalgaryCanada
  2. 2.Department of Surgery, Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
  3. 3.Concordia Hip and Knee InstituteWinnipegCanada
  4. 4.Department of Orthopaedic SurgeryDalhousie UniversityHalifaxCanada

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