Factors In Delaying Or Declining Total Knee Replacement Surgery

Main Category: Pain / Anesthetics
Also Included In: Rehabilitation / Physical Therapy;  Arthritis / Rheumatology
Article Date: 17 May 2008 - 3:00 PDT

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A study led by Dr. Ann F. Jacobson, associate professor in Kent State's College of Nursing, unveils the reasons why people may initially choose to postpone but ultimately undergo total knee replacement surgery and emphasizes the need for better patient education before and after the procedure.

Patients need more education and support about total knee replacement and making the decision to have it, and there is still a need for investigation into new and better ways to provide these, Jacobson says.

"This study sought to better understand patients' pre-and post operative experiences with total knee replacement surgery," says Jacobson. "These patients' perspectives have rarely been the topic of research yet numerous existing studies of total joint replacement of the hip or knee indicate that eligible patients delay or decline the procedure for reasons that haven't been well understood."

The Four Themes of Patient Experience

Study results identified four overarching themes in patients' experiences of total knee replacement, which the researchers named "putting up and putting off," "waiting and worrying," "letting go and letting in," and "hurting and hoping."

• A participant described "putting up and putting off" as, "I'm tired of it. I am a very active person." Another explained "putting off" the decision to have total knee replacement as, "you just keep hoping it will get better."
  
  
• The "waiting and worrying" stage begins after deciding to undergo surgery. One person said "I put this off for years. I can't wait to get it over with." This period involves worrying that "something can go wrong."
  
  
• The experience of "letting go and letting in" was described as "I had to accept the loss of control" and independence and "letting in" by accepting help and encouragement. One aspect of encouragement was hearing from others who had successful total knee replacement outcomes.

The "hurting and hoping" aspect of the experience was pervaded by pain: "The pain is the main thing with the knee," but also by hope: "Gotta keep your eye on the prize."

Patients yearned for a return to being a "normal human being," doing such everyday things as housework, walking the dog, or gardening, with ease and comfort.

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Source: Rachel Wenger-Pelosi
Kent State University

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