Orthopaedic surgeons typically use two tests to determine if a patient has recovered from hip surgery: one is a clinical measure of hip function given by the doctor, and the second is a questionnaire patients answer that considers a wide variety of factors in determining the overall success of the surgical procedure.
"We started out simply looking to see if the results of the two tests were correlated; the one doctors give has been used for decades to evaluate hip function, and the other that the patient answers is much newer," says Berton Moed, M.D., chair of the department of orthopaedic surgery at Saint Louis University School of Medicine. "What we found was surprising - the clinical test found good-to-excellent results, while the self-test taken by the same patients showed significantly worse recovery."
The disparity, says Moed, can be explained by a section of questions on the self-test not addressed by the clinical test: those dealing with emotional well-being. A patient's emotional status was the second-most important factor in determining how well he or she thought recovery was going, Moed found. (Mobility was the first.)
"Patients come in for check-ups after their hip surgery and the doctor says, 'Looks like you're doing fabulously,' and they respond, 'No, I'm not. I ache,'" Moed says. "They're not doing well, but why? It appears to have a lot to do with their emotional state. It's the elephant in the exam room - that is, something doctors need to acknowledge is a real issue."
Rather than retool the established clinical test to include an emotional component, Moed says orthopaedic surgeons should make efforts to use both exams for a more comprehensive measure of the patient's recovery.
"Do we need to look at other interventions besides fixing their hip? I think we might have to," he says. "That could include bringing in social workers and psychologists to work with the patients in the areas that surgeons, who often are super subspecialists, may not be able to deal with."
Moed says both underlying depression and new depression brought on by the injury and/or surgery could be to blame for slowing a patient's recovery.
"When an active person is suddenly confined to the bed or to limited activity, it can take a toll," Moed says. "Not being able to do the things one used - and feeling powerless over it - may play a larger role than we thought in how well the patient feels they're recovering."
While Moed says some patients may be taken aback by the suggestion that they see a psychologist after surgery, he thinks developing better and more customized treatment plans has the potential to help patients recover more fully - and not just after hip surgery.
"The number one issue is recognition - we need to acknowledge that there's more going on with patients than what current clinical tests tell us," he says.
Moed and fellow researchers studied 46 patients who had been followed for at least two years after elementary posterior wall fracture surgery. The research is published in the June issue of the Journal of Bone and Joint Surgery.
Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious disease.
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