Background
Methods
Sample selection and data collection
Data analysis
Results
Count | ||
---|---|---|
Age, average | 65 years | |
Sex | Female | 30 |
Male | 15 | |
Marital status | Married or common-law | 34 |
Widowed | 3 | |
Single, divorced or separated | 8 | |
Household income | < $40,000 | 12 |
$40,000 to < $60,000 | 10 | |
$60,000 to < $80,000 | 10 | |
$80,000 or more | 10 | |
Missing | 3 | |
Education | High school or less | 19 |
College/technical school | 12 | |
Undergraduate degree | 3 | |
Graduate degree | 8 | |
Other | 2 | |
Missing | 1 | |
Ethnicity | North American | 33 |
European | 8 | |
South Asian | 2 | |
Central/South American | 1 | |
Other | 1 | |
Received TKA surgery on first or second knee | First knee | 32 |
Second knee | 12 | |
Missing | 1 | |
Time between knee symptoms and first time seeing surgeon | <6 months | 9 |
≥6 to < 12 months | 9 | |
≥12 months | 25 | |
Do not remember | 2 | |
Satisfaction with TKA surgery results, self-evaluated 6 months post-surgerya
| Very satisfied | 8 |
Satisfied | 10 | |
Neutral | 15 | |
Dissatisfied | 9 | |
Very dissatisfied | 2 | |
Missing | 1 | |
Willing to have TKA surgery again, self-evaluated 6 months post-surgery | Yes | 25 |
Uncertain | 12 | |
No | 8 |
(1) Pre-surgical education session as a source of informational support |
“The [education session] is really informative….They prepare you for everything. If I went to the hospital without this program and woke up with my leg looking and feeling the way it did, I think I might have wanted a new limb.” |
“I went to all the pre-surgery meetings…But nobody ever really said, ‘This is not a real knee. This is not going to be the same as your other knee was. There will be limitations.’… I did read all the literature but nowhere did I see that said.” |
“The [education session] was pretty good but not good enough. I don’t think we really got enough warning about how much assistance you need afterwards…But maybe they can’t tell you what to expect because there’s so many differences in people too—it would take forever and maybe scare some people needlessly.” |
“I still don’t think that they explained how painful exercises are going to be at the pre-op session. You are told, but it doesn’t sink in. I think that should really be pushed. It is going to be painful but you can’t do any damage. Like, once the knee is in place, you can’t really harm it.” |
(2) Surgeons as a source of informational support |
“The one you really want to rely on is of course the surgeon. [You want to ask] ‘What did you do to me?’ or ‘What are you going to do to me?’“ |
“They are always in a hurry,… [My surgeon] showed me the x-ray. ‘And this is fine. It’s fine. You’re going to be fine.’…You are just a number and you just go and it’s quick, quick, quick.” |
“I think the hardest thing was [my surgeon]’s so hard to talk to…I think that probably was a lot of my problem, not feeling like I was given enough information.” |
“I only saw [my surgeon] a few times…a very nice person, very friendly to me. I wish I could see him more to get more information…but they have so many patients, [the visit is] so very fast.” |
“The surgeon, when I first met him, I thought, ‘Boy, that guy’s got no personality.’ When I got to know him I realized he does, but he’s a busy man. They are very busy. He’s willing to answer any questions but if you don’t have the questions to ask, how can they answer them?” |
“I wanted to know why I was so numb in my knee and [the surgeon] didn’t answer me. He just said ‘You’re going to have to give it time.’“ |
“You have to be really prepared and aware what you want to ask. You got to go in prepared because you get a little nervous. You get intimidated by these guys.” |
“[My surgeon] walked us step by step. He showed me what the surgery would do and what it would look like and then he showed me the x-rays of my knee and he explained everything that was going on…I can’t praise him enough.” |
(3) Other health care providers as a source of informational support |
“My family doctor is fine but he—perhaps because of the little bit more complexities in this case, he really didn’t have any opinions of his own about things. He really deferred everything to the surgeon.” |
“When I went for physio, the therapist kept on saying, ‘It’s going to be a year.’ And so that gave me hope too because when I first went there, I thought I’d be better already. I would have thought ‘A month has gone. What’s wrong here?’“ |
“The [physiotherapists] here tell you to get on with the exercises and don’t back off on that. They did point out quite emphatically that if you have pain, use the medication. Don’t back off on the exercise because of pain. If the knee hurts, take a pill. Don’t stop bending it.” |
“The physiotherapists set you up with a program. You’re only allowed to go for three visits. So you are cramming in three visits all these exercises which you are supposed to do. And rather than following up, people just go back to their old patterns because no one is checking up.” |
(4) Other TKA patients as a source of informational support |
“We are all comparing scars [saying] ‘Oh, your scar is so much nicer than mine.’” |
“If I had met [another TKA patient] who would have told me the honest truth—‘This could happen’ or ‘I had this happen’ or ‘There’s quite a bit of pain at first,’ you know, this sort of thing. I might have had more questions to ask [the surgeon].” |
“My girlfriend is getting it done so she was asking me different things… I did tell her to go to all the physio…. I said that through other people that were in physio, I did hear that [her surgeon] was a good doctor.” |
“I think seeing where other people are at [physiotherapy] gives you incentive too and makes you say, ‘I should be able to do this.’ Or ‘I should be working at it harder.’” |
(5) Informational support for pain expectations |
“I don’t think it’s stressed enough and I don’t think I ever read or heard before I had the surgery that the pain is not going to go away for a year. I thought [it would go away] in a month” |
“I thought it would be better than it is…The twisting pain I’m hoping will get less but it’s still pretty severe…I thought my knee wouldn’t hurt when I walked down the stairs, and maybe it won’t, given some more time. I am constantly told ‘Wait, wait, wait.’ so, I’m waiting. I just expected less discomfort after this period of time.” |
“The meeting at the hospital before you went in for surgery where they were explaining kind of what is going to happen. And they kept saying, ‘Oh, yes, you’ll have a little pain.’ I wish they had been a little bit more honest as to the amount of pain.” |
“I got mixed messages particularly when I went to physio. One person would say to me ‘Oh well, don’t do it if it hurts.’ Another person would say ‘Well, that’s the way it is.’…It’s a bit confusing.” |
“[After my first knee replacement] I was afraid to push it too hard because I didn’t know if I was going to do damage because of the pain. This time [for my second knee replacement] I knew I couldn’t really do any harm…I think probably for a lot of people the pain with the exercises, they are not prepared for it.” |
(6) Informational support for pain management |
“I’m frustrated [by the pain]… I’ve been back to my GP a few times saying, ‘Come on, there’s got to be something.’ ‘No, you are doing great.’ I go to physiotherapy. He says, ‘Oh, look at the movement in your leg. You are doing terrific.’ Okay, I am doing terrific but it hurts.” |
“The physiotherapist said it’s breaking down scar tissue which tends to form. You have to break it down to get the range of motion. And that gets uncomfortable. So bear with it. Use the pain killers as necessary but don’t let pain restrict your recovery.” |
“I kept on talking to [my family] doctor saying, ‘I don’t want to get [addicted].’ They say, ‘Take the pain medication, the pain medication. Manage it so you can move it.’ And I said, ‘Well, I don’t want to get addicted to it.’ ‘Oh, don’t worry about that, don’t worry about that.’ But I did worry about it.” |
“I think that if I’d had somebody I could call, even a couple of times like now and say, okay, it’s seven months, I’m in pain, the swelling is really bad today, what the hell do I do?” |
“There is nobody to talk to. You call the surgeon and unless there is like a major problem they don’t want to hear it from you because all they care about is what the x-ray shows and the x-ray shows perfect. It’s fine. The GPs, they didn’t do the surgery so it’s more pain control—like, ‘Do you want stronger pain pills?’ And I said no. I don’t want to just cover up the symptoms. I need to know what is going on. So you can get on the internet and check things, but there is nobody to really talk to about the pain, the swelling.” |
(7) Informational support about recovery trajectories |
“Unless I’m the exception. I don’t know if everybody has [these problems]. ….It would be nice for them to say, ‘Okay. This is the scenario. Some people may get full movement back but some people may not,’ you know. If they could let you know those options but they didn’t. |
“My brother had both of his [knees] done two years previous and a friend of mine had hers done and the neighbour across the street had hers done with the same doctor that I got it done with so I kind of knew what to expect.” |
“I should have sat down with [my neighbour] longer because he’s had his knees done…I’d like to have a phone-a-buddy, to phone somebody that’s had an knee operation the same time I did and ask ‘How’s your recovery going?’“ |
(8) Informational support about other post-surgery issues |
“Nobody said anything about the clicking…It kind of [worried me] because I was wondering if there was something wrong, that it shouldn’t be like that. And, of course, I got told it was quite normal. Everybody’s knee pretty much does it. And he explained why, which was good. Once I got the information and I understood that it wasn’t a big deal, it was fine.” |
“[The surgeon should] take some time to really explain to somebody what’s really going to happen, like, what your expectations should be. You may not have the pain you had before but this knee is going to make noise when you walk. This knee is going to feel like it’s crunching inside your leg. You’re going to have quite an ugly scar. You’re knee won’t be shaped the same as your other knee anymore.” |
“This [part of my knee] is still numb. I asked about that. [My surgeon] said, ‘Oh, it may never come back.’ It looks very different than my other knee. I know I’ve got ugly knees but it’s small. This is smaller. It gets warm still and that’s something the physio said is not good… [My knee is] a lot better than it was but it’s certainly not as good as I would like it to be.” |
(1) Surgeons as a source of clinical support |
“[My surgeon] has a good reputation. The hospital thinks the world of him…So I went to visit him and it was just a great match. He covers all the bases and tells you everything. There’s no secrets, no big surprises. He said if everything goes well, I’d only be in the hospital three days. That’s what it was.” |
“[My surgeon was] not really reassuring or anything. Very matter of fact…very ‘It’ll be this way. If that doesn’t happen, this will happen and we’ll do it that way.’ And basically that was it…he wasn’t very personable…It wasn’t any kind of conversation. It was very quick.” |
“[The surgeon] said, ‘I just wish I had more patients that were like you, that were healing quicker.’…I felt good because he did a good job and I felt good because I’d done a good job doing my exercises and everything. It was a win for both of us.” |
“[My surgeon] is so caring…even when I am crying he is like, ‘Oh, we’ll do this. We’ll get through it.’…I knew that he was going to help me.” |
“I think the minute he heard or saw my psychiatric file, I think he probably thought this person isn’t worthy of a knee replacement.” |
“The surgeon is useless to get information out of…6 weeks [after the surgery] I went in there and he said to me something which I didn’t understand and I’m sorry I never pursued it.” |
“I’d saved up these questions. I wanted to know if it was cement or screwed in. I wanted to know if the scar was the way it should be, if the numbness should be there. He answered my questions but in a very different way than I would have assumed he’d answer them. I would think that rather than make it sound so ordinary—this isn’t an ordinary thing.” |
(2) Physiotherapists and physiotherapy as a source of clinical support |
“Physiotherapy is the one thing you can count on.” |
“I went to physio twice a week and each week I could tell, getting in and out of the vehicle and walking into the hospital, I could feel that it was getting stronger.” |
“[The physiotherapist’s] attitude was all help. If you needed help, she helped. Very positive, saying things like ‘Work through the pain, you’re doing great, just push a little harder.’” |
“I went to rehab at the hospital and I could have done it as long as I wanted. They were fantastic. And it was all covered. I never got asked to pay for anything, it was all covered.” |
“One of the things they worked on [in physiotherapy] that I found very helpful, so did other people, was they developed a camaraderie, this big family get-together type of thing, to talk to people, compare notes and get a little encouragement from patient to patient. So it wasn’t just an isolated one-on-one therapist to patient. There was a lot of dialogue between patients.” |
“They were sending in a referral to [hospital name] for physio. I was given a phone number to call. So the first week home I called and they said there is nothing available yet…I was getting very desperate and in about the fourth week I started calling other hospitals… I was almost in tears. I was at my wits end, didn’t know what to do. And the woman in reception there said, ‘This isn’t acceptable, I’m going to talk to the physio and I’m going to call you back. I’m sure we will fit you in.’ She phoned back the next day…Without them—if they would have taken the same attitude as everybody else—I probably still wouldn’t be able to bend my knee.” |
(3) Family doctors as a source of clinical support |
“I have a GP who has been with me through the whole pain medication process, to the reduction of opiates, to the pre-surgery consult through the referral. He took my staples out at the end of the surgery. He followed me along through the recovery process post-surgery to make sure there was no infection. He followed along with the physiotherapist’s recommendations.” |
“I think my GP does know [that I still have unresolved pain in my knee]. I think he does. He knows I am under a lot of stress, a combination of the pain and being a caregiver. But there is nothing he can do. He can only give me so many Prozac and so many painkillers.” |
“I did go to the GP about my knee and asking him for advice on what I can do because the system isn’t doing it. And he suggested Aquafit.” |
“I don’t talk to my family doctor about it because he’s not interested. That’s the surgeon’s problem. [My family doctor] doesn’t want to get involved.” |
(1) Family and friends as a source of personal support |
“My son has been very helpful. He’d do the shopping or the laundry and cleaning or drive me places to my appointments.” |
“My wife and daughter were trying this idea of one on each side and then three people abreast across can’t go up the staircase. But our nurse friend knew how to negotiate all that.” |
“There are people here in the co-op. They were only a phone call away if I needed anything. They’d phone, ‘I’m going grocery shopping. Do you need anything?’“ |
“I needed to get to a physio…I didn’t want to impose on [my friends] to drive me over there and sit for an hour. But I couldn’t really trust my husband because he’s got dementia.” |
“The whole surgery thing made [my husband] very anxious. So his daughter had come to stay with us for a couple of days…and once I had the surgery she left. So I had to get back on my feet almost immediately and I was driving within 10 days, you know, could just barely move my foot but I could move it enough, to drive the car.” |
“[My friend] said, “Well, we can’t go walking or do anything because you’re an invalid. You can’t walk.’ So my social life has gone downhill.” |
“Our church family was so supportive too…It’s incredible, the cards, the phone calls, the meals I would get…it shows they care. I think that is such a huge part of recovery.” |
(2) Other TKA patients as a source of personal support |
“[My friends who had knee surgery] knew what it was all about and they told me how important it is. ‘Do your exercises. Don’t put them off.’ And when I could see how well they were doing, it encouraged me.” |
“I talked to more people that are waiting to have [their knee replacement] done to encourage them. I find that a lot of people are scared and I try to encourage them because I say you just won’t believe how you feel the day after your surgery to have that pain anymore.” |
“I spoke to about half a dozen people that had it and they were all walking around, they were fine, they were back to playing sports and doing whatever.” |
(3) Self as a source of personal support |
“I was prepared and knew you need to have a toilet riser, you need to have a cane, you need to have a walker… I even went to the Red Cross and got everything there.” |
“One of the things I learned [before surgery was] change your life before [surgery] and you’ll heal better. Which I did. I stopped drinking. I’m not a big drinker but I totally stopped alcohol.” |
“I was very good about doing all my exercises every single day, twice a day as they told me. I went to physio on my own after I ran out of physio at the hospital, which I have no coverage for so that was another three hundred and fifty bucks [out of my pocket.]” |
“I was also an active participant in the process which I think has got to be one of the keys to it. You can’t be a passive person and let them kind of do things to you because ultimately you have to be responsible for your own rehabilitation and recovery, be involved in it right from the very beginning.” |
(4) Employers as a source of personal support |
“The union is supportive. The company is supportive… People try to be as accommodating as they can if somebody needs help.” |
“So I postponed going to work for that month, plus I work for a doctor and she knows what is involved, and she said, ‘No, definitely take another month off, take the time that you need.’” |
“I am not at full time yet. I am working five hours a day. I hoped to increase that but my knee would keep flaring up and I couldn’t attend at all. Work has agreed to rent a recliner. Sometimes my knee is swollen and I need to keep it up. That’s the difficult part.” |
“We have a really good extended health care program. They covered everything….I had to get a pool pass. He just said, ‘Just send us a receipt. We’ll cover you.’” |
“I’ve had some issues with my employment, about getting back to work and its very aggravating and its very stressful…after two months they were phoning me, ‘You can come back to work.’… But then I said I also have physio. There’s where they have a fine line: you go to physio and now you’re on sick time again.” |
“I went back to work and did full time for three months and I just crashed. I couldn’t do it anymore… My manager was…unsympathetic.” |