By Mark Huffman
ConsumerAffairs.com
March 11, 2010
If you're contemplating joint replacement surgery, make sure you establish clear communication with your surgeon in the process leading up to the operation. Otherwise, you might be sorely disappointed with the outcome.
A study presented at the recent meeting of the American Academy of Orthopedic Surgeons documents a pronounced disconnect between the doctor's expectations for the outcome of this surgery and the patient's. The researchers suggest steps are needed to bridge this "expectation gap."
The study team was led by Hassan Ghomrawi, Ph.D., MPH, a researcher at Hospital for Special Surgery (HSS) in New York.
Two joint replacement surgeries included in the study are known technically as total hip replacement (THR) and total knee replacement (TKR). These procedures are common in individuals over 50 and usually result from normal wear and tear that causes osteoarthritis. At Hospital for Special Surgery alone, nearly 4,000 THRs and 4,000 TKRs are performed each year.
Before each surgery, patients attend a 90-minute class where they receive specialized education about the procedure and what they can expect afterward. The objective is to give the patient a realistic expectation of what their recovery will be like. Even then there can be misunderstandings.
In a study that compared expectations of 42 patients with their doctors through surveys, investigators found clinically meaningful disagreement in 68 percent of patients with 53 percent of the patients' expectations exceeding the expectations of the surgeons.
No idea
Lucy, of Richmond, Va., had a knee replacement in August 2009 and said she was totally unprepared for the aftermath.
"I had no idea of the trauma of a knee replacement," she told ConsumerAffairs.com. "Not just the pain immediately after the operation but the pain that's part of the recovery."
Lucy's surgeon provided a short video about the procedure and she attended an orientation class given by a nurse therapist. But neither the video, the therapist nor her surgeon really told her what to expect.
"It wasn't until I found a blog on the Internet and read the accounts of dozens of other knee replacement patients that I realized my situation wasn't abnormal," Lucy said.
"The take home message for the surgeon is that inexpensive, educational interventions like a preoperative class can be used to better align the patient's and the surgeon's expectations prior to surgery," said Alejandro Gonzalez Della Valle, M.D., associate attending orthopedic surgeon at HSS, who was involved with the study. "This may ultimately result in higher perceived outcome."
Unrealistic expectations
"If a patient has unrealistic expectations that are not properly trimmed preoperatively or achieved after surgery, the patient will most likely be dissatisfied with some aspects of the final result.
Conversely, if the patient has low expectations for function after surgery, it is likely that he or she will not enthusiastically engage in the different phases of the postoperative recovery including physically therapy. That patient will probably have a lower than expected functional result.
"For the patient, the take home message is that it is paramount to discuss the expectations for pain relief and function with the surgeon and in the class before undergoing a total joint replacement to make sure that the expectations of the physician and the patient are similar," said Dr. Gonzalez Della Valle.
