No major effects of preoperative education in patients undergoing hip or knee replacement--a systematic review.

INTRODUCTION The outcome of total hip (THA) and knee arthroplasty (TKA) may be optimised through preoperative patient education (PPE). It is hypothesised that PPE reduces anxiety, ensures realistic patient expectations and enhances post-operative outcome. The objective was to determine whether the literature supports a positive effect of PPE on post-operative outcomes including anxiety, pain, length of hospital stay (LOS), patient satisfaction, post-operative complications, mobility, and expectations. METHODS PubMed and Embase searches were performed on 1 October 2014. Randomised studies of preoperative edu-cation (written, verbal and audiovisual) imparted by health professionals to patients were included. RESULTS A total of twelve studies including 1,567 participants were identified. Six studies involved patients undergoing THA, five studies involved both THA and TKA, and one study TKA only. No convincing evidence in favour of PPE on outcomes regarding pain, LOS, patient satisfaction, post-operative complications, mobility and expectations was found. However, there was evidence for a reduction in preoperative anxiety. CONCLUSION PPE has not been shown to affect post-operative outcomes - except for a significant reduction in preoperative anxiety. However, this conclusion may be flawed by the general heterogeneity of the pooled studies. Hence, there is a strong need for properly designed randomised and controlled studies that are sufficiently powered, performed in generalised optimised hospital settings including optimised logistics and clinical enhancements that allow for discrimination between outcome parameters.