JOA - 2026-06-01 - Journal Article; Observational Study
Understanding Patient Expectations and Outcomes After Total Knee Arthroplasty: A Cross-Sectional Indian Study.
Singh Kushwaha N, Singh S, Kumar Chaudhary S, Singh A, Kumar S, Kumar A
Topics
Key Takeaway
In Indian TKA patients, pain relief expectations were fulfilled in 91% but culturally specific activities (squatting 36%, sitting cross-legged 29%) were met far less often, with 80% overall satisfaction at one year.
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Summary
This study evaluated preoperative expectations and their postoperative fulfillment in 300 Indian patients undergoing primary TKA at a single tertiary center, using the modified HSS Expectation Survey, WOMAC, VAS, and a 5-point Likert satisfaction scale. Pain relief (91%), walking (85%), and household activities (82%) were the most fulfilled expectations, while squatting (36%) and sitting cross-legged (29%) were poorly met. Overall satisfaction was 80%, with fulfillment of pain and ambulation expectations significantly associated with higher satisfaction (P<0.05); no difference was found between CR and PS implant recipients.
Key Limitation
Cross-sectional single-center design with no control group and no preoperative functional baseline scores, preventing determination of whether lower deep-flexion fulfillment reflects implant design, patient selection, or pre-existing range-of-motion deficits.
Original Abstract
BACKGROUND
Total knee arthroplasty (TKA) is a well-established treatment for advanced knee osteoarthritis. While it offers major pain relief and functional improvement, patient satisfaction often depends on how well postoperative outcomes align with preoperative expectations. In culturally diverse settings like India, specific activities such as squatting and sitting cross-legged may influence patient perceptions of success. This study aimed to evaluate the expectations of Indian patients undergoing TKA and assess their fulfillment after one year.
METHODS
A cross-sectional observational study was conducted at a tertiary care center in North India from January 2021 to December 2023. There were 300 patients aged ≥ 50 years who had primary osteoarthritis who underwent unilateral or bilateral TKA using either posterior-stabilized or cruciate-retaining implants were included. All patients completed one year of follow-up. Preoperative expectations were assessed using a modified Hospital for Special Surgery Expectation Survey. Postoperative outcomes were evaluated using Western Ontario and McMaster Universities Osteoarthritis Index, visual analog scale for pain, and a five-point Likert scale for satisfaction.
RESULTS
Pain relief (91%), walking (85%), and daily household activities (82%) were the most commonly fulfilled expectations. Expectations for squatting and sitting cross-legged were met in only 36 and 29% of patients, respectively. Overall, 80% of patients reported being satisfied or very satisfied. Fulfillment of expectations related to pain and ambulation showed a significant positive association with higher satisfaction (P < 0.05). There was no significant difference observed between cruciate-retaining and posterior-stabilized implant recipients.
CONCLUSIONS
While core functional goals are largely met, cultural expectations often remain unfulfilled after TKA in Indian patients. Preoperative counseling that addresses realistic goals may enhance satisfaction and patient-centered care.