Published online Oct 18, 2018. doi: 10.5312/wjo.v9.i10.220
Peer-review started: April 28, 2018
First decision: June 15, 2018
Revised: June 22, 2018
Accepted: June 27, 2018
Article in press: June 27, 2018
Published online: October 18, 2018
The background, present status, and significance of the study should be described in detail. It is known that patient-related factors, socioeconomic factors and education influence patient outcomes in general, however this area is difficult to investigate and thus these factors are often confounding in scientific work. These factors are also known to be of significance in patients scheduled to undergo total knee arthroplasty (TKA), and this study provides information regarding the significance of education and ethnicity in these patients.
During recent years, a trend towards optimized care, standardized patient evaluations and fast-track surgery has been influencing orthopaedic surgery. Although beneficial in many ways, this concept may not be appropriate for all patients. Levels of education and ethnicity is known to influence patients, and understanding the significance of these factors in TKA patients will assist healthcare providers in optimizing treatment plans for individual patients.
The objectives of this study were to determine if level of education and ethnicity influence the preoperative status of patients undergoing primary TKA or patient expectations for surgery. The significance of ethnicity and level of education on outcome following TKA is still uncertain and should be an objective for future research.
We prospectively included 829 patients undergoing TKA. Patients filled in pre-operative questionnaires with information regarding place of birth, duration of education, expectations for outcome of surgery and baseline characteristics. Statistical analyses were performed to identify the significance of ethnicity and level of education.
We find that patients undergoing TKA in a country different to where they were born report more severe preoperative symptoms and lower expectations for postoperative outcome. We also found that patients with a longer duration of education report more severe pre-operative symptoms. We found that patients of minority ethnicity and with an education > 12 years had more severe symptoms post-operatively. However, due to a low response rate, we cannot draw generalizable conclusions about these results. The significance of ethnicity and education on post-operative results remain to be sufficiently described.
Minority ethnicity and duration of education influence preoperative disability and expectations in patients undergoing TKA. Patients undergoing TKA in a country different to where they were born need individualised evaluation to accommodate potential differences from the general patient population. Patients of minority ethnicity report more severe pro-operative symptoms before undergoing TKA and lower expectations for post-operative outcome. Patients with educations longer than 12 years report more severe symptoms before undergoing TKA. Minority ethnicity and duration of education influence preoperative disability and expectations in patients undergoing TKA. Ethnicity and education influence patients’ perception of disease. Socioeconomic factors should be considered when evaluating patients.
Our study provides knowledge regarding the significance of ethnicity and education on preoperative disability and expectations of outcome. This information is key for healthcare professionals when evaluating patients prior to TKA, as it allows for the identification of individuals who may not be suitable for a standardized information regimen. It is important to investigate the significance of socioeconomic factors on outcome following TKA.