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Unfulfilled preoperative expectations have a strong influence on the outcome after total knee arthroplasty (TKA). More insight into determinants of the level of expectations is useful in identifying patients at risk for having expectations of the treatment result that are too high or too low. This information can be used in optimizing preoperative expectation management. The aim of the current study was to analyze to what extent preoperative outcome expectations of TKA patients are affected by psychological factors, demographic factors, pain, physical function, and general health status. We performed a cross-sectional analysis of 204 patients with symptomatic and radiographic knee osteoarthritis (OA), scheduled for primary TKA. Outcome expectations were measured using the hospital for special surgery knee replacement expectations survey. Independent variables included were age, sex, body mass index, and patient-reported outcome measures for pain, physical function, quality of life, anxiety, depression, catastrophizing, optimism, and pessimism. Multiple linear regression analyses were used to evaluate associations between these variables and preoperative outcome expectations. Female sex, higher age, higher depression score, and duration of complaints > 50 months showed to be significant predictors of lower expectations for the treatment outcome after TKA. Baseline pain and function scores were not related to the level of preoperative expectations. The present study aids in identifying patients at risk for having either too high or too low expectations. This knowledge can be utilized in individualized expectation management interventions., Competing Interests: None declared., (Thieme. All rights reserved.)

The rate of satisfaction after total knee arthroplasty (TKA) is consistently reported around 80%, leaving one in five patients unsatisfied to some extent. Fulfillment of expectations is reported as the strongest predictor of treatment satisfaction. In this study, we aimed to evaluate what Dutch orthopedic surgeons assume are realistic expectations for recovery 1 year after TKA. We invited the members of the Dutch Knee Society (DKS) to fill out a web-based questionnaire. For expectation measurement, the validated Dutch version of the Hospital for Special Surgery (HSS) knee replacement expectations survey was used. A total of 150 invitations were successfully sent; 84 orthopedic surgeons responded (56%). The overall HSS knee replacement expectation score was 66.0 (standard deviation, 14.0) on a 0 to 100 scale. Most improvement was predicted for the items "pain relief" and "walking short distances." Expectations related to patients' ability to kneel or squat after TKA were scored poorly. To the opinion of the members of the DKS, after TKA improvement can be expected in domains of pain, function, activities, and psychological wellbeing. Return to normal is not likely to occur, especially in demanding physical activities., Competing Interests: Conflict of Interest: J.J.T., M.C.S., R.P.A.J., and M R. declare that they have no conflict of interest., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

In total knee arthroplasty (TKA), reconstruction of a neutral mechanical axis is of great importance. The main goal of this study was to compare the accuracy of alignment after conventional versus computer-assisted TKA. Additionally, the effect of computer-assisted surgery (CAS) on functional outcome was analyzed. Out of a consecutive series, 50 conventional TKA were compared with 50 computer-assisted TKA. Except for the use of CAS, all perioperative and postoperative interventions were comparable. Radiological outcome was analyzed on standardized standing long-leg radiographs. Functional outcome was assessed using the Oxford Knee Score (OKS) and the Knee Society Score (KSS). No significant difference in mean mechanical axis alignment between the two groups was found. The number of outliers deviating more than 3 degrees from the mechanical axis was significantly reduced by using CAS, with 50% outliers in the conventional group and 26% outliers in the CAS group (p = 0.023). At midterm follow-up, the OKS and KSS knee and function scores did not show statistical difference between the two groups. The present study showed a reduction of the number of outliers exceeding 3 degrees from the tibiofemoral mechanical axis using CAS-TKA. This improvement in accuracy did not result in improvement of the functional outcome at mid-term follow-up.