Abstract
The aim of our study was to determine whether preoperative preparation by means of a video film could influence postoperative hip motion. The video shows a patient undergoing total hip replacement surgery covering the time period from admission to discharge, and keeping strictly to the patient’s perspective.
In 1958 Janis opened up the field of research on preoperative psychological states and postoperative recovery. Since then, numerous studies have been performed and a variety of variables were demonstrated to influence postoperative outcome. Our study takes into consideration the results of previous research and provides a new combination of methods for psychological preparation prior to surgery.
One hundred patients scheduled for elective total hip replacement surgery for osteoarthritis of the hip joint were randomly assigned to a control group (n=54) and a preparation group (n=46). The preparation group was shown the videotape on the evening before surgery. The video gives the pre-surgical patient the opportunity to identify with a patient who had successfully undergone surgery before. Physical examination, including motion analysis of the hip, was performed. Range of hip motion was documented in degrees with reference to neutral joint position.
Flexion/extension, abduction/adduction, and external/ internal rotation in 90° hip flexion were investigated. For range of motion analysis, sum scores were calculated.
Motion analysis revealed no preoperative difference between the groups. Three months after surgery, the increase of joint mobility (preoperative versus postoperative) in prepared patients was significantly better for internal rotation (32%, p=0.005), rotational range of motion (21%, p=0.03) and abduction (22%, p=0.04). Heterotopic ossifications were identified on plain AP radiographs and were judged according to the score of Brooker, et al. Incidence did not differ between groups. Twelve months postoperatively, the increase (preoperative versus follow-up) of rotational range of motion (24%, p=0.01) remained unchanged in prepared patients, whereas an increase of abduction could no longer be revealed. Flexion/extension and sagittal range of motion did not show any differences three and twelve months postoperatively.
Our videotape preparation led to an increase of motion after total hip replacement. Regarding rotational range of motion, this effect still remained twelve months after surgery.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
