PATIENTS’ PERSPECTIVES, PAIN, AND HEALTH-RELATED QUALITY OF LIFE IN SAME DAY DISCHARGE HIP AND KNEE ARTHROPLASTY

M.H. van Heerden¹, S. Lord¹, M.M. Keller¹

¹The University of the Witwatersrand, Therapeutic Sciences - Physiotherapy, Johannesburg, South Africa

Background: The development of international protocols for same day discharge (SDD) in lower limb arthroplasty(LLA) has resulted in shorter length of hospital stay. SDD following total hip (THA) and knee arthroplasty (TKA) has recently been introduced in South Africa challenging the status quo in private healthcare, and encouraging alignment with international trends. Comparisons between the recovery of THA and TKA patients in SDD are limited despite indications that there are differences in traditional length of stay studies. Pain is a common theme in the recovery phase in traditional length of stay following THA and TKA. The impact of SDD related to pain, health-related quality of life measures and the patients' perspectives has not been studied in the South African context.

Purpose: This study involves evaluating and exploring patients’ perspectives, pain, and health-related quality of life measures following SDD THA and TKA in South Africa. Furthermore, patient reported outcomes in THA and TKA are compared to determine whether there are differences between the two groups.

Methods: This is a quantitative study. Participants with osteoarthritis scheduled for arthroplasty, and who met the study criteria were selected through convenience sampling (sample size 110: 55 THA and 55 TKA). Participants completed the Numeric Rating Scale of pain preoperatively, on the day of surgery (before and after mobilising), in the first three days following surgery and at one, two, four and six weeks postoperatively. Short Form-McGill Pain Questionnaire-2, EuroQol-5D-5L and EuroQol Visual Analogue Scale of overall health were completed preoperatively and on day two, weeks two, four and six postoperatively. A mixed methods convergent design was used with concurrent collection of qualitative (participant interviews) and quantitative data. Descriptive and inferential statistics were used for data analysis. Interviews will continue to be conducted as data saturation has not been achieved.

Results: The quantitative data revealed significant improvements six weeks postoperatively when compared to initial preoperative scores in both groups. Individuals in the THA group experienced significantly more pain after mobilising on the day of surgery (p=0.029) compared to the TKA group who had significantly less pain (p=0.015). There were significant differences in neuropathic pain descriptors, pain intensity and health-related quality of life measures between the TKA and THA groups. The TKA group experienced more problems with pain and were slower to improve in quality of life measures. THA health-related quality of life improved faster than the TKA group.

Conclusions: Findings indicate that patients that are discharged on the same day following LLA in South Africa produce results comparable with those found in international studies. There is a significant difference in reported pain and health-related quality of life measures between TKA and THA in the six weeks following surgery.

Implications: Qualitative data is being collected to expand on patients' perceptions and experiences. This study may guide future management, research and potentially impact patient management. It may assist in developing clinical practice guidelines regarding the management of acute postoperative pain in TKA and THA.

Funding acknowledgements: No direct funding was received for this study.

Keywords:
Same Day Discharge
Total Hip Arthroplasty
Total Knee Arthroplasty

Topics:
Orthopaedics
Pain & pain management
Musculoskeletal: lower limb

Did this work require ethics approval? Yes

Institution: The University of the Witwatersrand, Johannesburg, South Africa

Committee: Human Research Ethics Committee (Medical)

Ethics number: M210534