Assessing the Ability of an Online Education Program to Modify Patient Expectations of Total Knee Arthroplasty Outcomes: Protocol for a Randomized Controlled Trial

TL;DR

This study tests an online education program to help patients set realistic expectations for knee replacement surgery, aiming to improve satisfaction and reduce healthcare burden.

Contribution

A novel presurgical educational program is developed and evaluated to modify patient expectations and improve outcomes for total knee arthroplasty.

Findings

The program will be tested in a randomized controlled trial with 150 patients.

Expectation fulfillment and satisfaction will be measured six months post-surgery.

Results will inform strategies to enhance patient care and health literacy.

Abstract

Patient satisfaction with total knee arthroplasty (TKA) is strongly influenced by alignment between expectations and outcomes. Despite a satisfaction rate of 80%‐90%, dissatisfaction affects 10%‐20% of patients and is expected to grow with the increasing volume of TKA procedures globally. Misaligned expectations, often driven by unrealistic or overly optimistic recovery views, can lead to unmet goals, dissatisfaction, and unnecessary health care usage. Addressing these gaps through improved presurgical education has the potential for enhancing patient satisfaction, optimizing outcomes, and reducing the burden on the health care system.

The main objectives of this study are to develop and evaluate a presurgical educational program, which focuses on patient expectations of surgical outcomes and facilitates patients setting realistic postsurgical goals. We will also assess the ability of the program to modify patient expectations, impact expectation fulfillment, improve satisfaction with postsurgical outcomes, and impact patient health literacy.

A targeted education program will be developed in consultation with key stakeholder groups, including consumer advocates, orthopedic surgeons, health care providers, and physiotherapy and rehabilitation specialists, to address realistic patient expectations of TKA outcomes. Alpha testing with consumers will provide insights into the appropriateness of the program being developed. The ability of the program to modify patient expectation will be assessed in a longitudinal, parallel group, 2-armed randomized controlled trial involving 150 patients identified by their orthopedic surgeon as requiring TKA. Randomly allocated participants will take part in the education program within 5 weeks prior to their scheduled TKA (intervention group) or will be allocated to standard preoperative education (control group). The primary outcome will be a change in the Hospital for Special Surgery Total Knee Replacement Expectations Survey–transformed score measured prior to and following the intervention. At 6 months following TKA, expectation fulfillment and overall satisfaction will be measured. Inferential statistics will be used to test for differences in, or associations between, outcome measures within and between study arms. The methods appropriate to both dependent and independent samples will be used, including nonparametric methods for data in violation of normality and variance assumptions.

The education program will be developed from January to September 2025. The randomized trial will run from October 2025 to March 2027, with data analysis completed by April 2027 and results published in peer-reviewed journals by September 2027.

This study will provide evidence on the effectiveness of a novel presurgical educational program in shaping patient expectations, promoting realistic goal setting, and improving TKA satisfaction. Findings will inform strategies to improve TKA patient care, health literacy, and satisfaction, potentially reducing dissatisfaction and associated burden on health care.