Preoperative education prior to elective knee arthroplasty surgery does not change patient outcomes

Abstract

Enhanced recovery programmes have improved outcomes following elective arthroplasty surgery. There are few studies assessing the role of patient education. In our enhanced recovery programme, all patients are offered the chance to attend a preoperative education class. Not all patients attend, enabling a comparison of outcomes. We have published data demonstrating that patients undergoing hip arthroplasty have improved outcomes. In the present article, we present data for total knee arthroplasty. Using a prospectively collected database, we identified all patients undergoing elective primary total knee arthroplasty. Data were assessed to look at patient outcomes. This was analysed using non-parametric tests. Between April 2009 and March 2013, 563 patients underwent elective total knee replacement. A total of 503 attended the class and 60 did not. Patients attending had a reduced length of stay when compared with the non-attenders but this did not reach statistical significance (4.13 days versus 4.57 days; p = 0.118). The spread of length of stay was slightly larger in the group that attended. Our analysis demonstrated that, for these patients, there is no statistically significant difference in length of stay or outcome scores. Therefore, in tougher economic times it may be prudent to focus preoperative education on total hip arthroplasty patients if resources are limited.

Total knee arthroplasty: improving outcomes with a multidisciplinary approach

“…However, randomized control trials, systematic reviews, and meta-analyses have failed to show consistent improvements in validated PRO scores, patient anxiety, LOS, functional outcomes, or complication rates. 24 , 28 – 31 This discrepancy is likely due to the large amount of heterogeneity seen with PPE sessions, duration, and time of administration between institutions. As such, we believe that PPE continues to be a valuable resource for patients and physicians alike.…”

The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty

“…In the most recent study by Riddle et al [ 63 ], patients receiving pain coping skills training did not have significantly better scores on WOMAC function and the short physical performance battery. Other types of education [ 42 , 44 , 48 – 50 , 55 ], music during physiotherapy [ 38 ], enhanced reality analgesia [ 69 ], cognitive behavioural therapy delivered by physiotherapists [ 56 ], and psychological support from a professional psychologist [ 23 ] did also not affect any of the functional outcome measures after TKA.…”

“…In the most recent study by Riddle et al [63], patients receiving pain coping skills training did not have significantly better scores on WOMAC function and the short physical performance battery. Other types of education [42,44,[48][49][50]55], music during physiotherapy [38], enhanced reality analgesia [69], cognitive behavioural therapy delivered by physiotherapists [56], and psychological support from a professional psychologist [23] did also not affect any of the functional outcome measures after TKA. Guided imagery is a widely used mind-body intervention by the generation of self-or practitioner-guided positive sensory and affective mental images to promote health changes in the body, reducing anxiety and stress, and evoking psychological and physiologic relaxation [61] # Intervention addressed to the recovery of physical function, the concerns during the recovery period and strategies for coping with pain after the operation delivered by trained therapistŝ…”

What are the postoperative experiences of patients who have undergone hip and knee joint replacement? A literature review

“…Across the UK, those undergoing surgery are given the opportunity to attend preoperative education sessions. These sessions typically provide information on the surgical procedure, hospital stay, challenges that may be encountered and often involves a multidisciplinary team including nurses, physiotherapists and occupational therapists (Conradsen et al 2016;Moulton et al 2017). The effectiveness of these preoperative education sessions is debated (Walker 2007).…”

“…The effectiveness of these preoperative education sessions is debated (Walker 2007). There is some evidence to suggest that that preoperative education may not improve pain, function, quality of life, individual outcomes or length of stay post hip and knee replacement (McDonald et al 2014;Moulton et al 2017). Conversely, others suggest that preoperative education help to prepare patients with positive outcomes including reduced length of stay and cost savings (Conradsen et al 2016;Edwards et al 2017).…”