Preoperative Education for Hip and Knee Replacement: Never Stop Learning

Abstract

Purpose of reviewParticipation in alternative payment models has focused efforts to improve outcomes and patient satisfaction while also lowering cost for elective hip and knee replacement. The purpose of this review is to determine if preoperative education classes for elective hip and knee replacement achieve these goals.Recent findingsRecent literature demonstrates that patients who attend education classes prior to surgery have decreased anxiety, better post-operative pain control, more realistic expectations of surgery, and a better understanding of their surgery. As a result, comprehensive clinical pathways incorporating a preoperative education program for elective hip and knee replacement lead to lower hospital length of stay, higher home discharge, lower readmission, and improved cost.SummaryIn summary, we report convincing evidence that preoperative education classes are an essential element to successful participation in alternative payment models such as the Bundle Payment Care Initiative.

Inpatient versus Outpatient Total Knee Arthroplasty

“…[56][57][58] A recent review article discusses how the spaced retention education method for rapid recovery total joint arthroplasty can be incorporated in a busy joint arthroplasty practice. 59 In response to recent discussions with CMS, AAHKS has offered the following evidence-based patient selection criteria to identify patient criteria for safe same-day discharge to home. To be considered for same-day discharge, a patient should undergo a thorough evaluation by the physical therapy team, demonstrating the ability to safely ambulate with assistance to and from the bathroom, ascend and descend two steps, and walk independently on ground level using an assistive device.…”

Psychological factors, prehabilitation and surgical outcomes: evidence and future directions

“…A systematic review of such interventions concluded that pre‐operative education reduces anxiety, postoperative pain and length of stay, and improved satisfaction . Such programmes have been incorporated into routine care for joint arthroplasty , and are an integral element of enhanced recovery after surgery pathways that have been demonstrated to improve surgical outcomes . More recently, surgery schools have been incorporated into enhanced recovery programmes, with apparent beneficial effects on outcomes, although it is not clear which elements of the package of care are most effective .…”

Perioperative Nursing Considerations for Patients Undergoing Total Hip or Knee Arthroplasty

“…Patients undergoing TJR may experience improved surgical outcomes and decreased anxiety when they attend preoperative education classes that address prevention of infections and venous thromboembolism (VTE), early ambulation, pain management, and rehabilitation needs (eg, procuring durable medical equipment) . Preoperative patient education providers should consider the learning needs and reading levels of their patients (ie, health literacy) when developing brochures and other written material.…”