Comparing the expectations of patients and their surgeons regarding the outcomes of periacetabular osteotomy

PURPOSE: The fulfillment of patients’ expectations is an essential factor in their satisfaction with outcomes of their surgery. It is therefore necessary to assess whether patients have realistic expectations of the likely effects of the prospective surgery on their symptoms and function. Comparison of the clinical outcomes anticipated by the patients and their surgeons provides important initial information in studying the formation of patients’ expectations. This study examined the level of agreement in the preoperative expectations of patients with DDH and their surgeons of the PAO surgery. METHODS: Two surgeons and their combined 72 patients preoperatively completed 4-point Likert-scales rating their realistic expectations of improvement (“not improved at all” to “greatly improved”) in six domains representing different hip symptoms after surgery. Domains included pain, stiffness, locking, stability, walking ability and athletic ability. Concordance between patient and surgeon expectation was evaluated by the percent of exact and partial (within one rating) agreement as well as Kappa coefficients. RESULTS: Exact agreement between patients and surgeons ranged from 17.4% (Stiffness) to 54.2% (Pain). Partial agreement between patients and surgeons ranged from 46.4% (Stiffness) to 100% (Pain). Agreement was consistently lowest regarding expected hip stiffness and highest regarding expected pain following surgery. Weighted Kappa estimates were low ranging from 0.07 to 0.45. In instances of disagreement, patients consistently had higher expectations than the surgeon especially with respect to stiffness, walking ability and locking/catching of the hip. CONCLUSIONS: There was discrepancy between patients and surgeons in their preoperative expectations of outcomes of the PAO, with most patients being more optimistic than their surgeons in every domain. In the domains of hip stiffness, locking, and walking ability, there was frequent discrepancy between patient and surgeon expectations. But for the pain domain, patients and surgeons were close in their expectations. Our findings highlight differences in perspectives between patients and surgeons regarding the effectiveness of the PAO in improving various hip symptoms and function