Planned lower-limb operations, such as knee and hip replacement, can be very effective treatments which are becoming increasingly commonly used.(1–3) Over 92,000 hip and 98,000 knee arthroplasty operations were performed across the UK in 2018, an increase of 53% and 37% respectively since 2007.(4) However, patient dissatisfaction after knee arthroplasty is high, estimated to range between 8–17%.(5,6)
Non-joint replacement operations are also common in the lower limb. It is estimated that over 15,000 ACLR (Anterior Cruciate Ligament Reconstruction) operations are performed in the UK each year.(7) Additionally, approximately 40,000 meniscal injuries requiring meniscectomy occur in the UK per year.(8) These procedures have also been impacted by overly optimistic expectations, which may lead to long-term dissatisfaction with their outcomes.(9)
Previous studies have measured satisfaction as well as functional outcomes or Patient Reported Outcomes (PROs) in lower limb surgery, concluding that three elements are key in maintaining high levels of satisfaction. These include meeting preoperative expectations, adequate pain relief and the patient’s subjective hospital experience. (10, 11) The strongest predictor of dissatisfaction after a total knee replacement has been found to be the failure to meet patients’ preoperative expectations, this has also been a factor in ACLR procedures.(12, 13) This demonstrates a lack of information being passed on the patient or a lack of understanding of the information being given.
Measuring outcomes has become an increasingly important tool in the field of medicine, however satisfaction largely remains an undefined and difficult to measure parameter, especially regarding information provision within a clinical setting.(14) Whilst PROs have become established, with a multitude of validated tools for healthcare quality measurements, patients are sometimes disappointed that questionnaires often do not ask the right questions from the patient’s perspectives.(12, 15) Even though evaluators use satisfaction as a single measure to reflect quality, the concept is multifactorial and requires capturing patient views more comprehensively than just the simple satisfaction scales frequently used in surveys.(16) To fully capture the patient experience, open ended questions and a more detailed assessment are needed to enable patients to offer a holistic view on the information and care they received.(14)
It has been suggested that by ensuring adequate patient education and realistic goal setting, patient satisfaction could be improved.(17, 18) Additionally, with the WHO’s global strategy on people-centred care and integrated health models becoming more prevalent, a simple yet effective method of ensuring the patient is at the heart of clinical decisions must be identified and utilised. This must provide relevant, effective and tailor-made information in the medium best suited to or requested by the patient, to ensure they are able to make the most informed decision possible.(19) To achieve both these targets, we must first ascertain if patients are satisfied with the information they receive, pertaining their operations.
Currently, information wise, patients receive a consultation with a surgeon, and an appointment with a physio prior to their operation, they may also receive a leaflet relevant to their operation. Patients undergoing joint replacement procedures will be invited to a group session to discuss exercises and extra support options. Post-operatively, all patients are given further appointments with their surgeon, and an appointment with a physiotherapist. With there being limited research in this field, the primary aim of this project is to evaluate patient satisfaction with the information given to them whilst under the care of the lower limb surgical team service within a tertiary orthopaedic centre in the West Midlands and identify ways to improve it. The project also aims to assess whether sub-groups of the patient population require different resources, in order to propose ways of achieving more effective information provision.