The Role of Hope on Outcomes Following Total Knee Replacement

Total hip and knee replacement are increasingly common elective surgical procedures in the UK, performed primarily for the relief of osteoarthritis in the majority of cases. Research has shown that individual psychological variables play a part in determining outcomes following these procedures. The literature review systematically examined the role played by patient expectations in outcomes following total hip and knee replacement. In addition, it examined the way in which both expectations and outcomes were conceptualised and measured in the literature. Finally, it sought to determine the theoretical underpinnings of expectations research. With the exception of one study, results showed that expectations do influence outcome. Weaknesses were identified in respect to the inconsistent approach used to measure both outcomes and expectations. A lack of theoretical underpinning of expectations was noted. Expectations may have implications for informing surgical selection and prognosis. Suggestions for future research in this area were made. The empirical study examined the role that hope might play in determining outcomes following primary total knee replacement for osteoarthritis. Much previous research in this area has been conducted from a deficit model of health. In contrast, hope is a positive psychological construct, which identifies and builds on individuals’ strengths. Pre-operative hope did not, as expected, directly influence outcome after surgery. It was found however, to be a significant unique predictor of pre-operative psychological morbidity and physical function, accounting for 9% and 10% of variance respectively. Both depression and function have been shown to influence outcome in this population. It could be argued that the pre-operative period is when the impact of osteoarthritis is most significant. Hope may be an important factor in delivering effective condition management at this time. Suggestions for future research and possible interventions based on these findings were advanced.