Effectiveness of pre-operative patient education for elective Total Hip and Knee Joint Replacement patients: Impact on pain levels, length of stay and post-operative complications

Abstract

Background: Ageing is associated with a dramatic increase in both the incidence and prevalence of osteoarthritis. The associated reduced bone mass is directly related to higher rates of fractures amongst older people, particularly fractured neck of femur. The most widely reported symptom of osteoarthritis is pain, which invariably pre-dates most fractures. Aside from analgesia, Total Joint Replacements, mostly hip and knee (TJR) in individuals with significant osteoarthritis and associated pain remain the mainstay treatments. As osteoarthritic fractures rates are increasing worldwide, so too are elective TJR. Managing the funding and meeting the demand for elective TJR has become a significant issue for the New Zealand health sector. Literature repeatedly reports that pre-operative patient education has a significant influence on reducing anxiety levels and hospital stay following hip and knee TJR surgery, resulting in overall cost savings for the healthcare facility and positive outcomes for the patients. Objective: This study explores the importance and effectiveness of patient education prior to elective joint surgery. The study will also examine the impact and role of a standardised pre-operative education programme on pain levels, length of stay, patient awareness of the surgery and potential post-operative complications. Participants: Interviews were held with 12 participants (six patients and six staff members). Patients had all previously undergone an elective joint replacement, of which three attended a standard pre-op education sessions and three had not. Postal survey questionnaires (with stamp-addressed envelopes) were distributed to 600 most recent patients who had undergone an elective THJR and TKJR at Auckland city hospital(ACH). A total of 149 survey questionnaires were returned (response rate=25%). 25 staff survey questionnaires were also distributed to orthopaedic registered nurses, with 24 returned (response rate = 96%). Furthermore, routinely collected inpatient data related to 941 patients who have had a THJR and/or TKJR surgery at ACH during the period 1 July 2012 to 30 June 2014 was analysed. Methods: The mixed methods involved three key stages: (i) Face-to-face interviews with patients and nursing staff, which were analysed using a general inductive method of enquiry; (ii) Postal surveys distributed to patients who had undergone an elective joint replacement, who had either attended or not attended a standardised pre-operative education programme; and (iii) Analysis of routinely collected patient data collected from ACH for the elective THJR and TKJR patients from 1 July 2012 to 30 June 2014. Results: The results highlight that the pre-operative education programme qualitatively prepared patients for surgery in several areas. Furthermore, patients who attended the pre-operative education programme reported statistically significant higher levels of preoperative exercise and practicing with crutches before the surgery compared to the patients who did not attend the education programme. Despite these findings, the programme did not statistically influence the length of hospital stay. Conclusion: The study demonstrated a positive relationship between the pre-operative education programme and pre-operative exercise and practicing crutches before the surgery. No influence on the length of stay or post-operative complications was identified.