Expectation Management and Joint Replacement

Aug 10, 2020

One of the chief sources of patient dissatisfaction after joint replacement is unmet expectations. This is principally driven by failure to achieve the degree of improvement or return to activities that patients desire. While there may be many reasons for this outcome, a frequent one relates to the margin for potential improvement that shapes patient’s subjective outcome from their surgery. Put another way, this means that the worse you are before surgery, the better you can get from surgery. Similarly, if you are not terrible in terms of pain and loss of function but motivated by other factors to have the surgery, your potential for improvement is limited. In the latter situation, you are more likely to be unhappy because the difference between and pre and postoperative comfort and function relative to the effort patients undergo to achieve their outcome is not sufficient to feel satisfied with the process.

In truth, joint replacement can rarely achieve a perfect 100% of normal state. If we as surgeons can reliably achieve 95% good to excellent results, patients who rate themselves as 25% of normal before surgery can get 70% better while those that rate themselves as 70% before surgery can only get 25% better. This metric, known as percent maximal improvement is an important for patients to consider when deciding to have a joint replacement given that it is an elective surgery. Having realistic expectations is important to be satisfied with the procedure and its results. Those with substantial preoperative disability and pain are often the most satisfied patients because they fit the paradigm of “the worse you are, the better you can get.”

With this in mind, our AVATAR program is designed to customize each patients experience to their needs. We strive hard to help patients navigate the decision to proceed with surgery based on realistic outcome. We base this information on our own results so that we can engage patients in a shared decision-making process that allows each patient to be in charge of their own process. This is part of our value proposition that we can deliver because we are a highly subspecialized joint replacement practice that can provide boutique-level care. Come see the difference with AVATAR.