Recent studies have shown that patient reported outcome measures (PROMs) may not completely reflect the satisfaction of patients with the intervention. The purpose of the study was to develop and validate a novel ‘patient reported fulfilment of expectation’ (PROFEX) questionnaire and to study the correlation between scores on PROMs (patient reported outcome measures such as SF-36 and WOMAC) and the post-operative fulfilment of expectations.

In this study, a novel 20-item ‘expectation’ questionnaire was developed, validated and administered pre-operatively to 523 patients who underwent total knee arthroplasty for osteoarthritis. The ‘fulfilment’ questionnaire was administered one year following the operation. Physician-reported (Knee Society Scores) and patient-reported (WOMAC, SF-36) outcome measures were also administered.

Both components of PROFEX questionnaire were found to have good reliability and internal consistency. No significant correlation existed between post-operative fulfilment scores and the ‘improvement’ scores of WOMAC, SF-36 and Knee Society scores. Lower pre-operative expectations were associated with higher post-operative fulfilment scores, but the magnitude of this correlation was low.

The lack of correlation between the scores on PROMs and the PROFEX scores shows that the scores on the PROMs do not reflect the sense of fulfilment of the patients with the outcomes. Instruments that directly measure fulfilment of expectations are necessary to gain insight into the requirements of the patients.

Level III: prospective comparative study.