Why People Delay Total Knee Replacement Surgery
August 18, 2008 – 7:03 pm
Our observations unveil the reasons why people may initially choose to delay but ultimately undergo total knee replacement surgery, underscoring the need for better patient education before and after surgery. Many patients have to work through a four-stage process of accepting the fact that they have knee pain and/or disability and overcoming their fear about surgery and the inevitable recovery process.
In seeking to describe patients’ experiences with total knee replacement (TKR), study results identified four overarching themes or stages in patients’ experiences of TKR, which are listed as follows:
- “putting up and putting off,”
- “waiting and worrying,”
- “letting go and letting in” and
- “hurting and hoping.”
One patient described the “putting up and putting off” stage as, “Pain limits what you can do.” Another said, “I’m tired of it. I am a very active person.” During the “waiting and worrying” stage, patients described “anxiety that is cursing my life” or worrying that “something can go wrong.” The “letting go and letting in” stage was described as “I had to accept the loss of control” in performing activities of daily living, and “letting in” translated to accepting encouragement, especially when hearing about other patients’ successful TKR surgical outcomes.
During the “hurting and hoping” stage, pain is the prevalent theme. Many patients understand thatpostoperative pain was inevitable and they would endure it. All who underwent surgery reported that immediate postoperative pain was intensified by movement of the leg and by physical therapy. For some, the pain level diminished daily; several reported that they were in less pain than they had anticipated.
“Hoping” translated to the participants’ wish to be able to perform various activities that they had previously been capable of doing without pain, including housework, gardening and walking the dog.
At the Neurologic & Orthopedic Hospital of Chicago, our joint replacement camp, preoperative, educates the patient on the knee replacement process and our perioperative pain management program with rapid recovery physical therapy serves as a model for orthopedic surgeons who come from around the world to study our methodology.
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