Stairway to heaven via the highway to hell: a qualitative study on patients’ experience of knee joint replacement surgery

Abstract Background Knee replacement (KR) is the most common osteoarthritis (OA) related surgery. Studies suggest that there are major international and national disparities in pre-operative information, support and access to rehabilitation which have a substantial impact on patients’ perceived outc...

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Main Authors: Anna Cronström, Thérése Jönsson, Gunilla Limbäck, Marcus Ljung, Caroline Ståhl, Elin Östlind
Format: Article
Language:English
Published: BMC 2025-06-01
Series:Journal of Orthopaedic Surgery and Research
Subjects:
Online Access:https://doi.org/10.1186/s13018-025-05989-5
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author Anna Cronström
Thérése Jönsson
Gunilla Limbäck
Marcus Ljung
Caroline Ståhl
Elin Östlind
author_facet Anna Cronström
Thérése Jönsson
Gunilla Limbäck
Marcus Ljung
Caroline Ståhl
Elin Östlind
author_sort Anna Cronström
collection DOAJ
description Abstract Background Knee replacement (KR) is the most common osteoarthritis (OA) related surgery. Studies suggest that there are major international and national disparities in pre-operative information, support and access to rehabilitation which have a substantial impact on patients’ perceived outcomes of the KR. The aim of this qualitative study was to explore experiences and perceptions of the care pathway in patients who have undergone KR and subsequent rehabilitation in Sweden. Methods Four focus group discussions were performed including in total 25 patients (16 women), median age 67.5 (range) (46–81 years), 1 to 15 months after KR. The discussion recordings were transcribed verbatim and were analysed qualitatively using content analysis with an inductive approach. Results The analysis resulted in four categories: (1) The crooked road towards surgery, (2) Needing support throughout the whole journey, (3) Feelings of psychological distress and (4) A balancing act towards a new life. A lack of pre-operative information regarding expected pain, need of support and mental well-being were described. Although the journey was sometimes tough, patients’ expectations were, however, often fulfilled and they were in general satisfied with the decision to undergo surgery. Conclusions Some of the challenges identified in this study may be alleviated by sufficient pre-operative information covering realistic expectations on surgery outcomes and mental aspects as well as emphatic and holistic support by healthcare providers. The result of this study will aid in the development and implementation of a national clinical practice guideline to ensure patient-centered care throughout the KR care pathway.
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spelling doaj-art-c8ffaaf0857f48418287cdb50909f7082025-08-20T02:05:38ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-06-0120111110.1186/s13018-025-05989-5Stairway to heaven via the highway to hell: a qualitative study on patients’ experience of knee joint replacement surgeryAnna Cronström0Thérése Jönsson1Gunilla Limbäck2Marcus Ljung3Caroline Ståhl4Elin Östlind5Department of Health Sciences, Faculty of Medicine, Lund UniversityDepartment of Health Sciences, Faculty of Medicine, Lund UniversityInstitute of Clinical Sciences at Sahlgrenska Academy, department of Orthopaedics, University of GothenburgUnit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping UniversityDepartment of Orthopedic, Ängelholm HospitalDepartment of Health Sciences, Faculty of Medicine, Lund UniversityAbstract Background Knee replacement (KR) is the most common osteoarthritis (OA) related surgery. Studies suggest that there are major international and national disparities in pre-operative information, support and access to rehabilitation which have a substantial impact on patients’ perceived outcomes of the KR. The aim of this qualitative study was to explore experiences and perceptions of the care pathway in patients who have undergone KR and subsequent rehabilitation in Sweden. Methods Four focus group discussions were performed including in total 25 patients (16 women), median age 67.5 (range) (46–81 years), 1 to 15 months after KR. The discussion recordings were transcribed verbatim and were analysed qualitatively using content analysis with an inductive approach. Results The analysis resulted in four categories: (1) The crooked road towards surgery, (2) Needing support throughout the whole journey, (3) Feelings of psychological distress and (4) A balancing act towards a new life. A lack of pre-operative information regarding expected pain, need of support and mental well-being were described. Although the journey was sometimes tough, patients’ expectations were, however, often fulfilled and they were in general satisfied with the decision to undergo surgery. Conclusions Some of the challenges identified in this study may be alleviated by sufficient pre-operative information covering realistic expectations on surgery outcomes and mental aspects as well as emphatic and holistic support by healthcare providers. The result of this study will aid in the development and implementation of a national clinical practice guideline to ensure patient-centered care throughout the KR care pathway.https://doi.org/10.1186/s13018-025-05989-5Knee osteoarthritisKnee replacement surgeryLived experienceQualitative researchQuality of care
spellingShingle Anna Cronström
Thérése Jönsson
Gunilla Limbäck
Marcus Ljung
Caroline Ståhl
Elin Östlind
Stairway to heaven via the highway to hell: a qualitative study on patients’ experience of knee joint replacement surgery
Journal of Orthopaedic Surgery and Research
Knee osteoarthritis
Knee replacement surgery
Lived experience
Qualitative research
Quality of care
title Stairway to heaven via the highway to hell: a qualitative study on patients’ experience of knee joint replacement surgery
title_full Stairway to heaven via the highway to hell: a qualitative study on patients’ experience of knee joint replacement surgery
title_fullStr Stairway to heaven via the highway to hell: a qualitative study on patients’ experience of knee joint replacement surgery
title_full_unstemmed Stairway to heaven via the highway to hell: a qualitative study on patients’ experience of knee joint replacement surgery
title_short Stairway to heaven via the highway to hell: a qualitative study on patients’ experience of knee joint replacement surgery
title_sort stairway to heaven via the highway to hell a qualitative study on patients experience of knee joint replacement surgery
topic Knee osteoarthritis
Knee replacement surgery
Lived experience
Qualitative research
Quality of care
url https://doi.org/10.1186/s13018-025-05989-5
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