Knee'd to Know Basis: Informed Consent in Total Hip and Knee Arthroplasty

An informational video for informed consent improves patient comprehension before total hip replacement- a randomized controlled trial

PURPOSE

Effective patient comprehension is critical for informed consent, particularly in Total Hip Arthroplasty (THA), a globally prevalent procedure. This study evaluates the efficacy of an informational video to improve the patients' understanding, self-perceived knowledge, and emotional comfort in the context of THA informed consent. This randomized controlled trial investigates the impact of an additional informational video on (I) the patients' understanding, (II) self-precepted knowledge and (III) emotional comfort during the informed consent process for THA.

METHODS

Participants were randomized to receive either the standard informed consent procedure or the standard procedure supplemented with an informational video. The effect of the video was tested with post-consent questionnaires.

RESULTS

The informational video significantly (p = 0.014) improved the patients' understanding from 78.6% to 86.5%. Self-precepted knowledge and Emotional comfort was not effected by the video (p = 0.986; p = 0.333).

CONCLUSIONS

The informational video significantly improved patient comprehension during the informed consent process before THA.

Internet-Based Patient Portals Increase Patient Connectivity Following Total Knee Arthroplasty

Many healthcare-related processes have undergone substantial transformation by the internet since the turn of the century. This technological revolution has fostered a fundamental shift from medical paternalism to patient autonomy and empowerment via a "patient-centric approach." Patient portals, or internet-enabled access to an electronic medical record, permit patients to access, manage, and share their health-related information. Patient connectivity following total knee arthroplasty (TKA) has the potential to positively influence overall outcomes, patient experience, and satisfaction. To understand current trends in patient portal usage, modalities of connectivity, and the implications following TKA. A systematic literature review was performed by searching PubMed and Google Scholar. Articles specific to portal usage and connectivity after TKA or total joint arthroplasty were subsequently identified for further review. Patient portals and internet-based digital connectivity platforms enable physicians, team members, and patients to communicate in the perioperative period both directly and indirectly. Communication can be through web-based patient portals, messaging services/apps, preprogrammed alerts (e.g., mobile applications or wearable devices), audio mediums, or videoconferencing. The spectrum and utilization of available patient engagement platforms continues to expand as the importance and implications of patient engagement and connectivity continue to be elucidated. Connectivity through patient portals or other mediums will continue to have an expanding role in all aspects of orthopedic surgery, patient care, and engagement. This includes preoperative education, postoperative rehabilitation, patient care, and, perhaps most importantly, collection of outcome measures. The level of evidence is V (expert opinion).

Should Body Mass Index Be Considered a Hard Stop for Total Joint Replacement?: An Ethical Dilemma

Total joint arthroplasty (TJA) is one of the most common surgeries performed in the United States and is a durable and effective option in managing osteoarthritis of the hip and knee. Recent research regarding the procedure has focused on preoperative optimization and weight loss in particular. Obesity has been shown in prior studies to increase risks associated with TJA, and, as a result, debate has focused on whether a body mass index (BMI) cutoff is a prudent tool for preoperative optimization. This article discusses the ethical dilemma of instituting a BMI cutoff and reviews current literature regarding the topic.

Goals of Care Discussions in Orthopaedic Surgery: Geriatric Hip Fractures

BACKGROUND

Due to the severity of hip fracture complications in the geriatric population, including major morbidity and mortality, it is crucial to establish treatment goals and manage expectations as a patient-centered multidisciplinary team. Goals of care (GOC) are personalized treatment programs designed to align with the individual patient's values and preferences. There is a paucity of literature on the topic of GOC discussions, especially regarding orthopaedic injuries. Therefore, this narrative review aims to provide an account of GOC discussions related to geriatric hip fractures.

METHODS

We reviewed articles published on GOC between 1978 and 2024. The articles were identified by searching PubMed and Google Scholar. We utilized the search terms GOC discussions and hip fracture, with additional descriptors including arthroplasty and geriatric.

RESULTS

There were 11 articles that met the selection criteria and were published between 1978 and 2024. Five articles were published on GOC discussions in orthopaedic surgery, while the remaining 6 articles were published in non-orthopaedic fields. There was one systematic review, 2 narrative reviews, 6 observational studies, and 2 descriptive studies. Supplemental commentary from non-orthopaedic specialties and the fields of law and medical ethics was included to assist in highlighting barriers to GOC discussions and to explore potential strategies to enhance GOC discussions.

CONCLUSIONS

Goals of care discussions provide a framework for treatment decisions based on an individual patient's values and cultural beliefs; however, these conversations may be limited by perceived time constraints, patient health care literacy, and physicians' misconceptions of what is most important to discuss. While no clear consensus was identified regarding strategies for improving GOC discussions in geriatric patients who have hip fractures, the authors recommend standardized training programs, expedited family meetings, multidisciplinary team involvement, assistive technology such as Outcome Prioritization Tool, and the incorporation of GOC discussions into institutional hip fracture pathways.