Bone and Joint Institute

Patient expectations for outcomes of upper extremity total joint arthroplasty: A systematic review

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Critical Reviews in Physical and Rehabilitation Medicine





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© 2020, Begell House Inc.. All rights reserved. Joint arthroplasty leads to a dramatic improvement in outcomes of pain, func-tion, and satisfaction for many patients. Patient expectations have been increasingly linked to these treatment outcomes, with positive expectations being associated with better outcomes and greater patient satisfaction. However, the majority of the literature focuses on lower, not upper, limb extremities. The purpose of this study is to identify and summarize studies that determine the extent to which preoperative expectations are predictive of postoperative outcomes in patients undergoing any arthroplasty of joints in the upper extremities. A comprehensive systematic online literature search was performed in Embase, Medline, CINAHL, PsycINFO, Cochrane Library, and Web of Science. Articles addressing joint arthroplasty in the upper extremities that measured preoperative expectations affecting postoperative treatment outcomes (pain, function, and satisfaction), as well as their relationships, were included, with an end result of eight studies reviewed. The methodological quality of the included articles ranged 53%–89%. Studies differed substantially in definitions and measurements of patient expectations. Only two reported a cor-relation analysis between patient expectations and outcomes. SF-12 function (p = 0.01), VAS pain (p = 0.05), and ASES function (p = 0.05) showed significant correlations with preoperative patient expectations. Findings show that research on upper limb arthroplasty is limited, unlike lower limb results. Future studies should focus on using preoperative patient education to modify expectations and on creating a framework to standardize patient expectations for arthroplasty of upper limb extremities.

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