| Objective:In our study we have compared patient satisfaction and surge-on satisfaction using a visual analogue scale (VAS) and one objective and one subjective scoring systems. The aim was to investigate whether or not there was a significant difference in satisfaction after THA between patient and surgeon.Material and Mehtods:Between February 2007 and February 2010,239 primary THAs were carried out on 212 patients.73 patients (86hips)were foll-owed up. The mean age at the time of operation was 57 years (17 to 81). At a mean follow-up of2.4 years (1 to 4),1 (1 hip) had died, and two hips (1 patient) had been revised. A further 2 patients (3 hips) were excluded because they had dementia or were too ill to undergo the examination. A total of 81 hips (69 patients) was assessed clinically In all patients, the posterolateral approach was used.All patients completed a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) form. The author took the history, undertook the clinical examination and completed Harris hip score (HHS). After being given standard Instructions, the patients scored a VAS for pain and satisfaction. The author who had not been involved in the surgery examined them. He asked about pain during rest and activity, walking ability, the ability to climb stairs, walking aids and assessed the walking pattern of the patient. After assessment of the radiographs he completed the surgeon satisfaction VAS form.The difference between the patient and surgeon satisfaction VAS was tested by the paired Student t test. The agreement of patient and surgeon satisfaction was obtained using the method of Bland and Altman. The relationship between the patient satisfaction VAS to HHS and five subjective systems (pain VAS, WOMAC pain, stiffness, physical function and the combined WOMAC scores) was determined using Pearson's correlation coefficient with correction for multiple testing. Unpaired Student's t-tests were used to determine if a significant difference in outcome was present between ankylosing spondylitis and femoral neck fracture groups after THA using HHS and satisfaction VAS score. Significance was set at a p value<0.05.Results:The mean (and standard deviation) analog rating for pain was 181.61±15.70 millimeters as assessed by the patients and 8.83±9.61 millimeters as assessed by the physicians (p=0.002, paired t test).54 patients rated the pain as less than 10 millimeters; their mean score was 3.26±2.76 millimeters, compared with 4.02±3.11 millimeters as assessed by the physicians (p=0.058, paired t test).21 patients rated the pain as 10 to 40 millimeters; their mean score was 20.29±9.18 millimeters, compared with the physicians'rating of 14.33±8.43 millimeters(p=0.000, paired t test). Pain was given a score of more than 40 millimeters by 6 patients; their mean score was 56.50±6.80 millimeters, compared with 33.00±3.58 millimeters according to the physicians. This association reveals that, as the patients' rating for pain increased, the discrepancy between their rating and that of the physicians also became greater (r=0.833, p< 0.001, linear regression).The mean analog rating for over-all satisfaction was 90.60±10.68 millime-ters as assessed by the patients and 92.91±6.79 millimeters as assessed by the physicians (p=0.024, paired t test).A similar trend was noted regarding the analog rating for over-all satisfaction.59 patients who rated their satisfaction as 9.0 to 10.0 millimeters had a mean score of 96.13±3.19 millimeters, which differed little from the mean score of the physicians (95.22±5.57mm millime-ters, p=0.087, paired t test).17 patients rated their satisfaction as 70 to 89 millimeters; their mean rating was 80.17±5.76 millimeters, compared with 87.29±8.71 millimeters as assessed by the physicians (p=0.021, paired t test).5 patients who rated their satisfaction as less than 70 millimeters had a mean rating of 60.80±10.28 millimeters, compared with the physicians' mean score of 84.80±4.44 millimeters (p=0.001, paired t test). Thus, when the patients'rating for over-all satisfaction decreased, the difference between their rating and that of the physicians increased (r=0.820, p< 0.001, linear regression). The correlation between the patient satisfaction VAS and the other scoring systems varied between 0.46 and 0.63. Pain during activity had the highest correlation with the patient satisfaction VAS(r=0.63, p<0.001).The average follow-up hip score (HHS) for hips with ankylosing spond-ylitis is 76.33±9.40, for femoral head necrosis,92.61±4.21。The average follow-up satisfaction VAS by patients for hips with ankylosing spondylitis is 89.85±5.01mm, for femoral head necrosis,91.07±8.10mm。there was significant differ-rentce in hip score after THA between ankylosing spondylitis and femoral head necrosis groups (p=0.011), whereas according to the satisfaction VAS, both had a similar satisfaction (p=0.107)Conclusion:(1) Patient and surgeon satisfaction were not in good agreement for the satisfaction VAS.(2) When the patients' rating for over-all satisfaction decreased, the difference between their rating and that of the physicians increased.(3) Pain is the most important factor in patient satisfaction.(4) Patients with different diseases have different expectations of total hip arthroplasty.
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