Marital Support Can Improve Total Joint Arthroplasty Outcomes

Having live-in support, including that from a spouse, after total joint arthroplasty can improve surgical outcomes, according to a new study presented at the 2021 annual meeting of the American Academy of Orthopaedic Surgeons.

Until now there has been little research examining the effects of social support and marital status on clinical outcomes and patient-reported outcome measures after primary and elective total hip and knee arthroplasty, the researchers reported.

Overall, married patients or those with a live-in partner experienced shorter surgical times, shorter lengths of stay in the hospital, fewer post-operative emergency department visits, lower readmission rates and, for some of them, improved patient-reported outcome measures (PROMS) compared with those patients who weren’t married or who lived alone.

“As orthopedic surgeons, we help restore our patients’ mobility and strive to help our patients recuperate in an optimal environment,” said lead researcher Ran Schwarzkopf, M.D., MSc, associate chief, Division of Adult Reconstruction at NYU Langone Orthopedic Hospital.

“My patient population is based in New York City and, given our urban setting, there are factors to consider such as non-elevator or walkup buildings. It’s not uncommon for me to have a [total knee arthroplasty] or [total hip arthroplasty] patient who lives alone on the fourth floor. Having to go up and down stairs during recovery can be a major challenge or patients—even if they don’t reside in an urban area.”

He said that access to both physical and psychosocial support—mental, emotional, social and spiritual—is crucial following total joint arthroplasty.

For their study, “Effect of Marital Status on Outcomes Following Total Joint Arthroplasty,” Dr. Schwarzkopf and team retrospectively reviewed patients who underwent either procedure from 2016-2020 and divided them by marital status at time of surgery. There were 2,146 hip patients and 1,242 knee patients.

Demographics, clinical data and patient-reported outcome measures (PROMS) were collected for all patients, including American Society of Anesthesiologists class, length of stay, all-cause Emergency Department visits, 90-day all-cause readmissions, 90-day all-cause revisions and patient-reported outcome measures.

In the total hip arthroplasty (THA) cohort, 61% were married. In the total knee arthroplasty [TKA] cohort, 55% were married.

Broken down, married patients had significantly shorter surgical time (88.5 vs. 93.8 minutes) and Emergency Department visits (1.5% vs. 3.8%) for THA but not for TKA.

In both THA and TKA cohorts, married patients had shorter length of stay (THA: 1.4 vs. 2.0 days; TKA: 2.0 vs. 2.5 days), and a lower rate of 90-day all-cause readmissions (THA: 2.4% vs. 5.1%; TKA: 2.5% vs. 4.2%).

They were also more likely to be discharged home (THA: 97.9% vs. 91.1%; TKA: 94.3% vs. 89.7%) rather than to a rehabilitation center or nursing home.

Married patients in the THA cohort also reported higher PROM scores than nonmarried patients though there was no significant difference in the TKA group.

“These findings demonstrate the integral role psychosocial support can aid in the recuperation period,” Schwarzkopf said.

“It’s imperative that the multidisciplinary healthcare team conduct a proper preoperative patient evaluation to determine any restrictions the patient faces or areas requiring additional support to help ensure the health and safety of patients post-surgery and throughout recovery.”

Schwarzkopf explained to Orthopedics This Week that the THA patients saw better improvements in shorter surgical times and fewer post-operative Emergency Department visits because TKA patients suffer more pain through the recovery process.

“They have to move the knee to get motion back and pain is always a driver for Emergency Department visits.”

Their findings, he added, are important in regard to global health and the move to value care. With Medicare bundled payments, hospitals have to pay out of pocket if a patient needs to go to a rehabilitation center before going home. Because of this, payors are deincentivized to take on elderly patients who need the surgery the most.

It is an ongoing problem, he said. Some patients are just going to need rehabilitation.