Early recovery following lower limb arthroplasty: Qualitative interviews with patients undergoing elective hip and knee replacement surgery. Initial phase in the development of a patient-reported outcome measure.

To explore the patients' perspective of surgery and early recovery when undergoing lower limb (hip or knee) arthroplasty. Lower limb arthroplasty is a commonly performed procedure for symptomatic arthritis, which has not responded to conservative medical treatment. Each patient's perspective of the surgical process and early recovery period impacts on their quality of life. Open, semistructured qualitative interviews were used to allow for a deeper understanding of the patient perspective when undergoing a hip or knee arthroplasty. Following ethical approval, 30 patients were interviewed between August and November 2016 during the perioperative period while undergoing an elective hip or knee arthroplasty (n = 30). The interviews were performed between the day of surgery and a nine-week postoperative clinic appointment. Data were analysed using an in-depth narrative thematic analysis method. NVivo qualitative data analysis software was used. Seven main themes evolved from the interviews: "improving function and mobility", "pain", "experiences of health care", "support from others", "involvement and understanding of care decisions", "behaviour and coping" and "fatigue and sleeping". The early postoperative recovery period is of vital importance to all surgical patients. This is no different for the orthopaedic patient. However, identifying key self-reported areas of importance from patients can guide clinical focus for healthcare professionals. To have specific patient-reported information regarding key areas of importance during the perioperative phase is invaluable when caring for the orthopaedic surgical patient. It gives insight and understanding in to this increasing population group. This study has also served as a starting point in the development of a questionnaire which could be used to assess interventions in the lower limb arthroplasty population. These results will influence both items and content of the questionnaire.

Strickland LH ，Kelly L ，Hamilton TW ，Murray DW ，Pandit HG ，Jenkinson C ... -  《-》

The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement - a European study.

To describe and compare the quality of recovery on discharge from hospital among patients undergoing elective hip or knee replacement. The study will also attempt to identify any predicting factors. Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today's shorter hospital stay may be a challenge for the patients during the early period of recovery. It is therefore important to identify factors associated with quality of recovery at discharge from hospital. A descriptive, comparative study including 12 hospitals in 5 European countries; Cyprus, Finland, Greece, Iceland and Sweden. Consecutively included patients responded on: health-related quality of life, and emotions before surgery and at hospital discharge; quality of recovery, patient satisfaction and fulfilment of knowledge expectations. Related factors and associations were analysed separately for each kind of arthroplasty. In total, 865 patients were included (hip n = 413, knee n = 452). In the dimension of pain, patients undergoing hip replacement had significantly better quality of recovery compared to those undergoing knee replacement. Both patient groups experienced negative emotions before surgery that were related to poorer quality of recovery. Fulfilment of knowledge expectations has a limited effect on quality of recovery. Greater satisfaction with care predicted better quality of recovery. Negative preoperative emotions were related to poorer quality of recovery. For both kinds of arthroplasty, greater satisfaction with care was associated with better quality of recovery. The result emphasises the need to detect patients in need of support in their preparation and recovery process, taking into account the perspective of their emotional state.

Johansson Stark Å ，Charalambous A ，Istomina N ，Salanterä S ，Sigurdardottir AK ，Sourtzi P ，Valkeapää K ，Zabalegui A ，Bachrach-Lindström M ... -  《-》

Patients' satisfaction and experiences during elective primary fast-track total hip and knee arthroplasty journey: A qualitative study.

To explore how satisfied patients are with the process of treatment and care and to identify the experiences that patients perceive during elective primary fast-track total hip and knee arthroplasty journey. Greater satisfaction with care has predicted better quality of recovery, and patient experience has been positively associated with patient safety and clinical effectiveness. However, a little is still known about how patients experience their treatment and care. A qualitative interview study. The study was conducted among 20 patients in a single joint replacement centre during 2018. Patient satisfaction was measured using a numerical rating scale. Patients' experiences were identified through qualitative semi-structured interviews which were analysed using an inductive content analysis method. The COREQ checklist was used (Supporting Information). The mean numerical rating scale score for overall satisfaction was 9.0 (SD 1.1) on a scale from 0-10. The patients' experiences were grouped under eight main categories that were derived from the qualitative data in the analysis: (a) patient selection, (b) meeting the Health Care Guarantee, (c) patient flow, (d) postdischarge care, (e) patient counselling, (f) transparency of the journey, (g) communication and (h) feedback. The findings suggest that patients are highly satisfied after an elective primary fast-track total hip and knee arthroplasty. However, closer analysis of the patients' experiences reveals challenges and suggestions on how they could be solved, often involving digital technologies. As the number of total joint arthroplasties grows, patients and their families need to take ever greater responsibility, for their own care from advance preparation to rehabilitation. The findings of the study can be used to organise work, improving patient-clinical communication, fostering engagement and improving patient centredness. In addition, the results pinpoint the issues on how the patient experience could be improved.

Jansson MM ，Harjumaa M ，Puhto AP ，Pikkarainen M ... -  《-》

Patients' experiences from an education programme ahead of orthopaedic surgery - a qualitative study.

The objective of this study was to investigate how patient education in a surgical department was experienced by patients who had undergone total knee arthroplasty or total hip arthroplasty. Total knee arthroplasty and total hip arthroplasty are two of the most common and clinically effective surgical treatments performed in the Western world. Patient education efforts related to these procedures have been studied, but usually only to evaluate clinical outcome and little in a patient perspective. The empirics consist of qualitative in-depth interviews with 11 patients admitted to the surgical department at a Norwegian hospital. The interviews were carried out in 2011. The study has a qualitative design with a phenomenological approach. The data have been analysed through meaning condensation, in accordance with Amadeo Giorgi's four-step method. N = 11. The education programme made the patients feel mentally prepared for surgery and the postsurgical situation. Three themes were identified: (1) realistic information preparing for surgery, (2) involvement and sense of control and (3) trust in staff. A relationship seems to exist between how informed patients feel and how much they trust the department in which they are undergoing treatment. There may also be a relationship between a sense of control and trust. To build a trustful relationship between healthcare providers and patients, patient education both in groups and individually should be implemented, and be designed in a way that supports trust. Information should be realistic and accurate.

Conradsen S ，Gjerseth MM ，Kvangarsnes M 《-》

The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery: development and economic modelling.

Price A ，Smith J ，Dakin H ，Kang S ，Eibich P ，Cook J ，Gray A ，Harris K ，Middleton R ，Gibbons E ，Benedetto E ，Smith S ，Dawson J ，Fitzpatrick R ，Sayers A ，Miller L ，Marques E ，Gooberman-Hill R ，Blom A ，Judge A ，Arden N ，Murray D ，Glyn-Jones S ，Barker K ，Carr A ，Beard D ... -  《-》