Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2018; 9(10): 220-228
Published online Oct 18, 2018. doi: 10.5312/wjo.v9.i10.220
Does ethnicity and education influence preoperative disability and expectations in patients undergoing total knee arthroplasty?
Madeline Therese Kudibal, Thomas Kallemose, Anders Troelsen, Henrik Husted, Kirill Gromov
Madeline Therese Kudibal, Anders Troelsen, Henrik Husted, Kirill Gromov, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
Thomas Kallemose, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
Author contributions: Kudibal MT, Troelsen A, Husted H, and Gromov K contributed to study conception and design; Kudibal MT, Kallemose T, and Gromov K to data acquisition, analysis and interpretation; Kudibal MT and Gromov K contributed to writing the article; all authors contributed to editing, reviewing and final approval of article.
Supported by the Danish Rheumatism Association, No. R111-A2587.
Institutional review board statement: No approval from the National Ethics Committee was necessary as this was a non-interventional observational study. Permission to store and review patient data was obtained from the Danish Data Protection Agency Jr, No. 2007-58-0015.
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
STROBE statement: the STROBE checklist was adopted in preparation of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Madeline Therese Kudibal, MD, Doctor, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Kettegård alle 30, Hvidovre 2650, Denmark. madelinetherese@hotmail.com
Telephone: +45-53-669073
Received: April 28, 2018
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
Processing time: 173 Days and 1.6 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.