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    Joint Replacement Surgery Improves Quality of Life for the Patient’s Significant Other, Too

    A great deal of research has been done on outcomes of total joint arthroplasty in patients with osteoarthritis of the hip or knee, including reduced pain and emotional distress and improved function. Comparatively little is known, however, about the impact of these outcomes on the patient’s significant other.

    A new study is changing that: Michael Tanzer, MDCM, FRCSC, FAAOS, and his colleagues from McGill University Health Center in Montréal, Québec, Canada, have found that the significant other’s quality of life also improves when their partner experiences a positive outcome of total hip arthroplasty (THA) or total knee arthroplasty (TKA).

    The study was scheduled for presentation at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS), canceled due to the COVID-19 pandemic, and has now been released in the AAOS Virtual Education Experience.

    “It started with a thank you note,” said Dr. Tanzer, lead author and Jo Miller Chair of Orthopaedic Research at McGill University Health Center.

    “My patient’s wife wrote to tell me how delighted she was to have her husband’s quality of life back because of the dramatic effect it had on her own life and their marriage. This one gesture of gratitude made me think about the impact of joint-replacement surgery in a way I had taken for granted.”

    The significant other of patients with OA of the hip or knee often assume the burden of becoming a caregiver. This can create physical and emotional issues: Research has shown that spouses of individuals with persistent pain report lower levels of marital satisfaction, higher rates of depression, and a lower quality of life. [1,2]

    “For a condition that can be cured with surgery, there was no literature available discussing the burden on the caregiver or if negative feelings persisted because of the toll it’s taken,” Dr. Tanzer said.

    “We conducted a pilot study to evaluate the spouse’s perception of the patient’s pain and disability before and after THA or TKA. We also wanted to assess the degree to which patients and their spouses perceive themselves to be disabled, both preoperatively and postoperatively, and determine the ways in which the spouse’s personal and marital life improved after the patient’s successful hip or knee arthroplasty.”

    The retrospective study included a sample of 33 couples (66 respondents) with an average age of 68 years (range, 48 to 86) for the patients and 67 years (range, 48 to 86) for the spouses. On average, couples had been married for 36.5 years. To participate in the study, couples had to have been married or cohabitated with their partner for at least 5 years prior to surgery.

    Of the 33 patients included in the study, 29 underwent THAs and 4 underwent TKAs. These patients had been living with a diagnosis of OA for an average of 7 years, while the average wait time to receive an operation was 8.7 months. All patients reported they had completely recovered from their surgery at the time of the study.

    Findings of the study revealed:

    • Patients rated the level of their preoperative pain significantly lower than their spouse. The patients rated the level of their preoperative pain as 7.5 out of 10, while their spouses rated their preoperative pain as 8.2 (P=0.05).
    • At the time of the survey, the patients felt their pain had improved to 0.9 after the surgery, while their spouses continued to report their pain as significantly worse at 1.5 (P=0.05).

    For patients, the most significant ways in which the surgery affected their quality of life included:

    • Improvement in mobility (85%)
    • Resuming their favorite leisure and sporting activities (73%)
    • Improvement in pain (70%)
    • Improvement in their social and family lives (33%)

    The spouses also indicated that their lives had improved with respect to participating in physical and leisure activities with their partner. The main advantage of the patients’ arthroplasty surgery included:

    • Ability to carry on with social and leisure activities with their partner (70%)
    • No longer witnessed the patient suffering (61%)
    • Diminished caregiver burden (54%)
    • A sense of independence to resume their normal life (54%)
    • Improved marital relationship (54%)
    • Improved social and family life (27%)
    • Freedom to travel (27%)

    “As an orthopaedic surgeon, it’s important to consider the well-being of your patient’s spouse and know that they, too, are likely experiencing the burdens of living with a functional disability,” Dr. Tanzer said.

    “The emotional and social impact, as well as the physical challenges, can be many, and by continuing to research and bring more resources to the clinical setting, we can help both orthopaedic surgeons and patients create a better quality of life from diagnosis through to treatment.” 

    Source

    Tanzer M, Pedneault C. Marital Functioning and Spouse-Reported Improvements in Quality of Life after Joint Arthroplasty, Poster P0036. AAOS Virtual Education Experience.

    References

    1. Geisser ME, Cano A, Leonard MT. Factors associated with marital satisfaction and mood among spouses of persons with chronic back pain. J Pain 2005;6(8):518-525.
    2. Leonard MT, Cano A. Pain affects spouses too: personal experience with pain and catastrophizing as correlates of spouse distress. Pain 2006;126(1-3):139-146.