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Pre-operative education in total hip or knee arthroplasty

Three Part Question

In [adults undergoing primary total hip or knee arthroplasty] does [pre-operative patient education] reduce [inpatient length of stay]?

Clinical Scenario

The orthopaedic department has listed several patients for total hip or knee arthroplasty which is putting demand on bed turnover. It is hypothesised that a pre-operative education session would reduce length of stay post-operatively as an in-patient.

Search Strategy

AMED 1985 to March 2007, CINAHL 1982 to March 2007, Embase 1996 to March 2007, Medline 1996 to March 2007, Cochrane to March 2007 and Pedro to March 2007
[Hip Prosthesis/ or Arthroplasty/ or Arthroplasty, Replacement, Knee/ or Arthroplasty, Replacement, Hip/ or Joint Prosthesis/] AND [Education/ or Patient Education/]
Pre-op therapy education. mp, Pre-admission,
Limited to English Language.

Search Outcome

2 papers were found relevant to the 3 part question. One was a Cochrane review. There was 1 systematic review with meta-analysis.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
McDonald S, et al.
Patients undergoing hip or knee replacements 9 studies (n=782) 4 Studies looked at LOS (n=365)Cochrane review looking at pre-operative education on post-operative outcomes including anxiety, pain, mobility, length of stay (LOS) and incidence of DVTsLength of Stay (LOS)NSS for all four studiesThe results were inconclusive as this review included a number of post-operative outcomes which made it difficult to ascertain whether LOS was reduced with pre-operative education
Johansson K, et al
Hip and knee arthroplasty 11 studies (n=1044) 5 LOS studies (n = 512)Systematic review and meta-analysis.Length of Stay3 studies NSS and 2 studies SS. No other information available & no meta-analysis done.Small number of studies Included studies other than RCTs Limited to English Language studies Meta-analysis of length of stay outcome not performed.


Overall, pre-operative education for total knee and hip replacements does not reduce length of stay to a level of statistical significance. Patient education may still be of benefit to patients in different ways other than length of stay such as anxiety levels. Further research will help to determine more conclusive results in this area to help justify the cost implications of pre-operative education.

Clinical Bottom Line

Pre-operative patient education for these patients does not reduce length of stay.


  1. McDonald S, Hetrick S, Green S, Pre-operative education for hip or knee replacement (Review) The Cochrane Collaboration 26 January 2004, 1-23
  2. Johansson K, Nuutila L, Virtanen H, Katajisto J, Salantera S. Preoperative education for orthopaedic patients: systematic review Journal of Advanced Nursing 2005; 50(2): 212-223