Preoperative education modestly reduced anxiety and postoperative pain in patients undergoing elective hip or knee arthroplasty, but evidence does not support meaningful improvements in discharge timing, complications, or quality of life, according to a systematic review and meta-analysis published in Perioperative Medicine.
The review analyzed 19 randomized controlled trials involving 2,116 adults scheduled for primary hip or knee replacement. Educational interventions varied widely, including written materials, videos, group classes, and individualized counseling. Control groups received no structured education beyond routine preoperative consenting.
Across pooled analyses, preoperative education was associated with a small but statistically significant reduction in anxiety before surgery. Similar benefits were observed for patient knowledge and self-reported postoperative pain. By contrast, education showed no clear impact on length of stay, postoperative complications, or quality-of-life outcomes – endpoints often prioritized in high-volume arthroplasty programs.
The authors noted that the magnitude of anxiety reduction was small and of uncertain clinical relevance for individual patients, particularly given substantial heterogeneity across studies. However, they emphasized that preoperative anxiety is consistently associated with downstream outcomes such as analgesic use, engagement with rehabilitation, and postoperative delirium, suggesting that even modest effects may have value at scale.
No single educational format emerged as clearly superior. However, multi-component approaches that included opportunities for clinician interaction appeared more likely to benefit patients with higher baseline anxiety or greater informational needs, based on subgroup observations.
Rather than supporting a universal “education package,” the authors argued that preoperative education should be viewed as a targeted, adjunctive intervention. In high-volume arthroplasty pathways, scalable educational tools may be most useful when deployed selectively – focused on anxious or high-risk patients – and integrated with existing enhanced recovery programs rather than expected to drive hard clinical endpoints on their own.
They concluded that future studies should prioritize clearer intervention descriptions, standardized outcome measures, and identification of patient subgroups most likely to benefit, to better inform efficient, evidence-based preoperative education strategies in routine arthroplasty care.
Source: Perioperative Medicine