You’ll know when you’re ready: When the time is right for joint replacement surgery

Pool Exercises for Joint Pain, Arthritis Foundation.

Background.
While some studies have identified patient readiness as a key component in their decision whether to have total joint replacement surgery (TJR), none have examined how patients determine their readiness for surgery. The study purpose was to explore the concept of patient readiness and describe the factors patients consider when assessing their readiness for TJR.
Methods
Nine focus groups (4 pre-surgery, 5 post-surgery) were held in four Canadian cities. Participants had been either referred to or seen by an orthopaedic surgeon for TJR or had undergone TJR. The method of analysis was qualitative thematic analysis.
Results
There were 65 participants, 66% female and 34% male, 80% urban, with an average age of 65 years (SD 10). Readiness reflected both the surgeon’s advice that the patient was clinically ready for surgery and the patient’s feeling that they were both mentally and physically ready for surgery. Mental readiness was described as an internal state or feeling of being ready or prepared while physical readiness was described as being physically fit and in good shape for surgery.

Factors associated with readiness included:

  1. pain: its severity, the ability to cope with it, and how it affected their quality of life;
  2. mental preparation;
  3. physical preparation;
  4. the optimal timing of surgery, including age, anticipated rate of deterioration, prosthesis lifespan and the length of the waiting list.
Conclusions
Patient readiness should be assessed prior to TJR. By assessing patient readiness, health professionals can elucidate and deal with concerns and fears, understand and calibrate expectations, assess coping strategies, and use this information to help determine optimal timing, both before and after the surgical consultation.

You’ll know when you’re ready: a qualitative study exploring how patients decide when the time is right for joint replacement surgery, Conner-Spady BL, Marshall DA, Hawker GA, Bohm E, Dunbar MJ, Frank C, Noseworthy TW. BMC Health Serv Res. 2014 Oct 2;14:454. doi: 10.1186/1472-6963-14-454.

Also see
Understanding knee osteoarthritis from the patients’ perspective: a qualitative study, Victoria Carmona-Terés, Jenny Moix-Queraltó, Enriqueta Pujol-Ribera, Iris Lumillo-Gutiérrez, Xavier Mas, Enrique Batlle-Gualda, Milena Gobbo-Montoya, Lina Jodar-Fernández and Anna Berenguera. BMC Musculoskeletal Disorders. 201718:225 DOI: 10.1186/s12891-017-1584-3

Physical Activity Patterns Among Older Adults With and Without Knee Osteoarthritis in Six European Countries, Herbolsheimer F, Schaap LA, Edwards MH, Maggi S, Otero Á, Timmermans EJ, Denkinger MD, van der Pas S, Dekker J, Cooper C, Dennison EM, van Schoor NM, Peter R, Eposa Study Group. Arthritis Care Res (Hoboken). 2016 Feb;68(2):228-36. doi: 10.1002/acr.22669.

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