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The Meaning and Impact of the Benefits and Harms of Total Hip Replacement: A Review of Patient and Caregiver Experiences and Perspectives

Last updated: August 4, 2016
Project Number: RC0796-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What are the perceived benefits and harms of total hip replacement, and the meaning and impact of those benefits and harms, from the perspective of people who have received a total hip replacement?
  2. What are the perceived benefits and harms of total hip replacement, and the meaning and impact of those benefits and harms, from the perspective of non-clinical caregivers?
  3. What are the experiences and perspectives of people who have received a total hip or knee replacement and their caregivers regarding deciding between different available hip or knee implant options, in particular relation to paying out-of-pocket expenses for non-medically insured options?

Key Message

The main perceived benefit of total hip replacement from the perspective of patients that emerged from the included studies is the desire to return to everyday life without limitations. While everyday life looks different for each individual, participating in everyday life without limitations can include returning to work and activities of daily living, re-engaging in social relationships, and participating in leisure activities and hobbies. Returning to everyday life without limitations aligns with a desire for autonomy, independence, and dignity and a fear of being dependent on others.One perceived harm was described: prosthetic joint infection and the corresponding need for one or more revision surgeries. For study participants, this experience prevented them from returning to returning to life without limitations, and had a considerable and extended impact on themselves and their family members and caregivers. Infection and revision surgery introduced further pain and mobility restrictions, the need for lengthy antibiotic treatment, and considerable distress due to lost independence, an uncertain future, and the need for ongoing support through symptom onset, treatment and revision surgery, and recovery after treatment Side effects that emerged as important include pain and reduced mobility, worry and anxiety, frustration, and time needed to adjust to a new and foreign body part. Participants within most of the included studies described these side effects as barriers to them returning to everyday life without limitations but also acknowledged these as necessary experiences to healing. It is possible that younger people are more frustrated than older people by the limitations to everyday life introduced by hip replacement, including the need for caregiver support, mobility restrictions, the need to limit social interactions and an inability to work and drive.