Naturally as we age, our joints may experience degeneration that worsens over time. When this happens, the protective cartilage between our joints, wears down over time, causing new abnormal bone spurs which may elicit pain, stiffness, reduced range of motion, crepitus and/or swelling. A common orthopaedic procedure involves replacing the joint at end-stage degeneration to alleviate the symptoms; such as a total knee arthroplasty (TKA) or total knee replacement (TKR), as well as a total hip arthroplasty (THA). The total hip arthroplasty is one of the most cost-effective and consistently successful surgeries in orthopaedics.

Both THA and TKA aim to provide reliable outcomes for an individual’s suffering from end-stage osteoarthritis, pain relief, functional restoration and overall improved quality of life. In a THA, the head of the femur is replaced with a prosthetic head, and the joint surface of the acetabulum is lined with a synthetic joint surface. This post will help provide you with expectations on how to prepare for a total joint replacement! There is an abundance of information that can be discussed about each specific joint replacement, thus we will primarily focus on THA’s in this post.

Indications for Surgery

As mentioned previously, the most common indication for THA includes end-stage symptomatic osteoarthritis. Osteonecrosis is more prevalent in the younger population between 35-50 years and attribute to 10% of annual THA’s. Other indications for surgery may comprise of post-traumatic arthritis, rheumatoid arthritis, avascular necrosis. Congenital hip dislocation or dysplasia, or hardware failure. Prior to surgery, a full medical examination is completed to determine the risks and suitability. Imaging is used to assess the severity of the degeneration and any abnormalities. It is quite useful for the patient and surgeon to discuss expectations and precautions that occur post-surgery.

Depending on the direction of the surgical approach, specific precautions are given to patients to avoid dislocations post surgery. Commonly, surgeons will complete a posterolateral approach. Therefore, patients are informed to avoid:

• Flexing your hips past 90 degrees

• Crossing your legs (adduction past midline)

• Extreme internal rotation of the hip

Knowing of this information in advance can help prepare the individual and to help manage one’s expectations.

Pre-Op Assessment and Treatment Sessions

Interestingly, physiotherapy participation preoperatively has not been shown to improve postoperative outcomes. However, the importance of pre-op physiotherapy can play vital roles in the wait for surgery. Often times, people may be waiting many months for their surgery, and thus, pre-op physio can play an important roles towards improving one’s pre-op quality of life to prevent further deterioration. Additionally, a 6 week education and exercise program has been shown to improve pain and disability for those on the wait-lists. These individuals have shown improvements in function, knowledge, and psycho-social aspects.

Managing Expectations

A study published in 2009 from Mannion and colleagues looked at the role of patient expectations in predicting outcomes after a total knee replacement. They looked at different determinants of global outcome after TKA such as; baseline expectations, fulfilment of expectations, or current symptom and function. The study analyzed 112 patients who had osteoarthritis of the knee. They completed a questionnaire about their expectations from months to a full recovery, pain, and daily limitations in function post surgery. After two years, they were asked what the reality was in each domain and rated their satisfaction with the surgery. As a result, patients significantly underestimated the length of time to achieve full recovery. On average they expected 4.7 months, and in actual time, it took 6.1 months. They recalled being overly optimistic of being pain free and not being limited in day-to-day activities. Global outcomes were 46.2% excellent, 41.3% good, 10.6% fair and 1.9% poor.

This reveals that expectations did not predict global satisfaction of the patients after two years, but, the most important determinants were other joint problems and pain. In conclusion, the study found that this group had overly optimistic preoperative expectations of their TKA surgery. This study suggests that surgeons should assist in providing realistic expectations to the patient during pre-op consultation.

Interestingly, a different study published in 2016 compared patient’s expectations following a total hip arthroplasty or a total knee arthroplasty. The objective of the study was to assess the expectations pre-op and to correlate them with the degree of satisfaction post-op after 1 year. All of these patients had painful osteoarthritis. Neuprez and colleagues found that patients undergoing a joint replacement have a high level of expectations for either TKA or THA. Both surgeries significantly improve essential and non-essential activities and aid to quality of life, the rate of satisfaction is significantly greater in THA. The researchers found that pre-op expectations are a major contributor to the final degree of satisfaction. Similar to the previous study, this paper concludes the emphasis on pre-op interaction between health care providers and patients to foresee a reasonable outcome after joint arthroplasty. 

If you’re preparing for (or have already had) a total knee or total hip replacement then you need to check out our In-Home Physiotherapy services!

We can see clients in Vancouver, Burnaby, Richmond, Surrey or Langley!

Our client’s love our In-Home Physiotherapy, Acupuncture and Massage sessions because it allows them time to recover at home and the convenience of having exceptional rehab delivered to your door. Our clients don’t have to worry about arranging transportation, traffic or parking!

References

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167911

https://arthritis-research.biomedcentral.com/articles/10.1186/ar2811

https://www.physiopedia.com/Total_Knee_Arthroplasty#:~:text=Total%20Knee%20Arthroplasty%20%2D%20Physiopedia%20Definition,highly%20cross%2Dlinked%20polyethylene%20plastic