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Educate patients more extensively to help improve surgical outcomes
In my department’s daily practice of performing hip and knee joint replacement, we changed our approach to preoperative patient education in the last 2 years. For patients who are scheduled to undergo surgery in the near future, instead of merely providing them with preoperative information about the surgery and potential complications, we now offer a full program with patient-focused surgical education at its core.
The joint replacement education we now provide is open-ended and detailed. It deals equally with improving patients’ knowledge of the surgical procedure as well as their well-being after surgery. The program also is designed to reduce complications, including deep venous thrombosis, deep infection, dislocation of hip joint prostheses and periprosthetic fractures with the goal of improving overall outcomes.
Rapid recovery programs
The program has been a success and is now a regular part of the rapid recovery program used in all lower limb joint replacement cases performed at our hospital. However, there are clearly differences we need to be aware of between our strict joint replacement patients and other orthopaedic patients in terms of what they demand from us and other health care providers.
Consider how you would expect information and surgical education to be delivered if you required surgery for a health-limiting condition. My guess is you would definitely ask for advice about how to proceed, precautions about what to avoid and insights on those aspects of the treatment you should be particularly careful with or concerned about. Furthermore, you would likely request information about the next steps in the decision-making process and the expected outcomes at specific times after the procedure is performed.
One of my friends underwent total knee replacement (TKR) at an institution other than mine that also uses a rapid recovery patient program. The surgery and early rehabilitation went well and my friend was on target with what was expected for his case. At his last visit to the clinic at 8 weeks after surgery, he was “average” compared to other patients after TKR for range of motion, pain and mobility. But, when I visited him by chance 4 months after surgery he was limping. He clearly had a quadriceps deficiency and knee range of motion of 0° to 75°.
I asked my friend why he had not contacted the department to have his knee checked. His answer was, “Why?” Apparently, he simply thought that was a normal amount of activity and range of motion at that time point after surgery and, because he was doing well at the 8-week follow-up he received no further instruction or education about what his function and expectations should be during his postoperative course.
To me, he missed out on the detailed education about the personal training he needed to ensure he was still doing well at 12 weeks, 16 weeks and 24 weeks, and about the realistic expectations he should have at various time points after surgery.
Provide a complete education
My friend’s surgery is an example of what can occur when our patients do not receive the complete education they need to be better informed and to formulate realistic expectations after elective orthopaedic surgery.
The need to provide better education for orthopaedic patients does not stop there. We should also aspire to better educate trauma patients who present with different fractures. Although the trauma surgery setting clearly presents more challenges than the total joint replacement setting, patients with fractures stand to benefit even more from extra education about the procedures and about the possible outcomes.
All our patients can benefit from receiving more information about their specific procedure and what to expect in terms of postoperative outcomes. As the professionals who provide much of their care, orthopaedic surgeons should ensure patients get all the education they need. This practice will support the positive outcomes for which we all strive.
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- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Road, Thorofare, NJ 08086, USA; email: orthopaedics@healio.com.
Disclosure: Kjaersgaard-Andersen has no relevant financial disclosures.