Patient understanding and satisfaction in informed consent for total knee arthroplasty: A randomized study


  • Michael R. Johnson,

    1. University of Minnesota Medical School, Minneapolis
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  • Jasvinder A. Singh,

    1. Birmingham VA Medical Center and University of Alabama at Birmingham
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    • Dr. Singh has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from URL Pharmaceuticals, Savient, Takeda, Novartis, and Abbott; research and travel grants from Takeda, Savient, Wyeth, Amgen, the Arthritis Foundation, University of Minnesota, Cochrane Library, and Department of Veterans Affairs; and investigator-initiator grants from Allergan, Savient, and Takeda.

  • Thomas Stewart,

    1. University of Minnesota Medical School, Minneapolis
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  • Terence J. Gioe

    Corresponding author
    1. Minneapolis VA Medical Center and University of Minnesota Medical School, Minneapolis
    • Minneapolis Veterans Affairs Medical Center, Section 112E, 1 Veterans Drive, Minneapolis, MN 55417
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    • Dr. Gioe has received research support (more than $10,000) from Depuy, Inc.

  • The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US Government.



Informed consent is a critical component of all surgical procedures, but patients' understanding and recall of the potential risks/benefits is poor. We hypothesized that utilization of multiple standardized education modalities in the informed consent process would allow for better retention and a more informed patient.


A total of 151 patients undergoing primary total knee arthroplasty (TKA) were randomized to 3 groups: group 1 received standardized informed consent and a paper handout detailing the risks/benefits of TKA; group 2 received standardized informed consent, a paper handout, and a video discussing the risks/benefits of TKA; and group 3 followed the same process as group 2 plus formal nurse education. All patients completed a 15-item questionnaire (risks, indications, and expectations) immediately following this consent process on the morning of surgery and 6 weeks postoperatively. We used t-test and analysis of variance for data analyses.


There was no difference (P = 0.79) in satisfaction with the consent process between the 3 groups; 92–97% of the patients rated the consent process as good to excellent at all time points. The number of correct answers did not differ significantly between the groups at any time period (P = 0.31–0.81). Scores dropped significantly (P = 0.004) from preoperatively to the 6-week postoperative visit in all groups combined. A higher level of satisfaction with the process was reflected in higher scores preoperatively in all groups (P = 0.028).


Preoperatively, patients satisfied with the consent process may have better recall of risks/benefits and expectations of surgery. Neither retention nor satisfaction was influenced by reinforcement methods, such as video or nurse education; they may therefore be unnecessary.