Study shows improved marital relationship and spousal quality of life following joint replacement surgery

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American Academy of Orthopaedic Surgeons

May 19, 2020, 14:10 ET

ROSEMONT, Ill., May 19, 2020 /PRNewswire/ -- While individuals with osteoarthritis (OA) who undergo joint replacement surgery often experience reductions in pain, emotional distress and improved function, there is little known about how these recovery-related changes impact their spouse or marital relationship. A new study released as part of the American Academy of Orthopaedic Surgeons' (AAOS) Virtual Education Experience titled "Marital Relationship and Quality of Life in Couples Following Joint Replacement Surgery" found that a spouse's quality of life also improves when their partner experiences positive results, following total hip arthroplasty (THA) or total knee arthroplasty (TKA).

"It started with a thank you note," said Michael Tanzer, MDCM, FRCSC, FAAOS, lead author, orthopaedic surgeon and Jo Miller chair of orthopaedic research at McGill University Health Center in Montréal, Québec. "My patient's wife wrote to tell me how delighted she was to have her husband's quality of life back because of the dramatic effect it had on her own life and their marriage. This one gesture of gratitude made me think about the impact of joint replacement surgery in a way I had taken for granted."

Spouses of individuals with OA often assume the burden of becoming a caregiver. Research has shown that spouses of individuals with persistent pain report lower levels of marital satisfaction, higher rates of depression and a lower quality of life.^{i ii}

"For a condition that can be cured with surgery, there was no literature available discussing the burden on the caregiver or if negative feelings persisted because of the toll it's taken," said Dr. Tanzer. "We conducted a pilot study to evaluate the spouse's perception of the patient's pain and disability before and after THA or TKA. We also wanted to assess the degree to which patients and their spouses perceive themselves to be disabled, both preoperatively and postoperatively, and determine the ways in which the spouse's personal and marital life improved after the patient's successful hip or knee arthroplasty."

The retrospective study included a sample of 33 couples (66 respondents) with an average age of 68 years old (range, 48-86) for the patients and 67 years (range, 48-86) for the spouses. On average, couples had been married for 36.5 years and to participate in the study, couples had to have been married or cohabitated with their partner for at least five years prior to surgery. Of the 33 patients, 29 received THAs and four received TKAs. These patients had been living with a diagnosis of OA for an average of seven years, while the average wait time to receive an operation was 8.7 months.

Couples participated in an interview, separate from their partner. All patients reported they had completely recovered from their surgery at the time of the study.

Findings of the study revealed:

Patients rated the level of their preoperative pain significantly lower than their spouse.

The patients rated the level of their preoperative pain as 7.5 out of 10, while their spouses rated their preoperative pain as 8.2 (p=0.05).

At the time of the survey, the patients felt their pain had improved to 0.9 after the surgery, while their spouses continued to report their pain as significantly worse, being 1.5 (p=0.05).

For patients, the most significant ways in which the surgery affected their quality of life included:

Improvement in mobility (85%)
Resuming their favorite leisure and sporting activities (73%)
Improvement in pain (70%)
Improvement in their social and family lives (33%)

The spouses also indicated that their lives had improved with respect to participating in physical and leisure activities with their significant other. The main advantage of the patients' arthroplasty surgery included:

Ability to carry on with social and leisure activities with their partner (70%)
No longer witnessed the patient suffering (61%)
Diminished caregiver burden (54%)
A sense of independence to resume their normal life (54%)
Improved marital relationship (54%)
Improved social and family life (27%)
Freedom to travel (27%)

"As an orthopaedic surgeon, it's important to consider the well-being of your patient's spouse and know that they too are likely experiencing the burdens of living with a functional disability," said Dr. Tanzer. "The emotional and social impact as well as the physical challenges can be many and by continuing to research and bring more resources to the clinical setting we can help both orthopaedic surgeons and patients create a better quality of life from diagnosis through to treatment."

Disclosure Statement

About the AAOS
With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world's largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level to best treat patients in their daily practices. The AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal health care issues and it leads the health care discussion on advancing quality.

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ⁱGeisser ME, Cano A, Leonard MT. Factors associated with marital satisfaction and mood among spouses of persons with chronic back pain. J Pain 2005;6(8):518-525.
ⁱⁱ Leonard MT, Cano A. Pain affects spouses too: personal experience with pain and catastrophizing as correlates of spouse distress. Pain 2006;126(1-3):139-146.

SOURCE American Academy of Orthopaedic Surgeons