Preoperative education for total hip and knee replacement patients

Objective. Psychoeducational preparation is known to improve postoperative outcome. We tested two common psychoeducationaI procedures in elderly ortho pedic patients, examining how best to match interventions to patients by ps ychological type. Methods, Two hundred twenty-two elderly patients undergoing total hip or kn ee replacement were randomly assigned to 1) a slide-tape with information o n the postoperative, in-hospital rehabilitation experience, or 2) training in Benson's Relaxation Response with a bedside audiotape, in a 2x2 factoria l design. Results. The relaxation response did not influence postoperative outcomes, The educational intervention reduced length of stay and pain medication use for patients who exhibited most denial (tendency to avoid thinking about u npleasant events), and reduced postoperative anxiety and cognitive errors o n the Mini-Mental State Exam for patients with most baseline anxiety. There Il as no effect on postoperative pain. Conclusions. The importance of attending to the patient's psychological sta le and level of preparation before orthopedic surgery is reinforced. Patien ts who exhibit most denial and highest anxiety may benefit fr om educationa l interventions, but patients' directly expressing desire for information m ay be a poor guide in deciding which patients would benefit, compared with more formal psychological testing for denial and anxiety.