Impact of Anxiety and Fear of Surgery on Willingness to Undergo a Hip or Knee Arthroplasty

Introduction: Hip and knee arthroplasties are two of the most common orthopedic procedures and both have high rate of success. However, there are still patients who refrain from undergoing these operations despite significant decrease in their function and quality of life.

Anxiety from surgery is a well-known reason for the decline in the results of surgery, but it is unclear how much it affects the willingness to undergo surgery.

In this study, we studied patients who refrain from surgery and compared them to patient with an opposite decision. Anxiety, fear of surgery and function were compared between the two groups.

Methods: This is a combined prospective and retrospective study.

The study group was constructed from all the patients referred to knee or hip arthroplasty between August 2015 and August 2016. All patients who were not operated at our hospital one year after the referral were contacted by telephone and asked whether they had had the surgery at another hospital. Thus, the study group consisted of the 50 patients who have chosen not to undergo a surgery.

A control group consisted of 25 prospective patients who were admitted for a knee or hip arthroplasty.

Patients in both groups were evaluated for their level of anxiety (STAI questionnaire), fear of surgery (Surgical fear questionnaire), and function level (Oxford knee or hip score).

Results: There were no significant differences in function or anxiety levels between the two groups.

Fear of surgery was much higher in the study group (55.6) than in the control group (35.1) and this difference was statistically significant (p<0.001).

In the study group, there was a statistically significant negative correlation between the fear of surgery and the function (meaning that patients who are afraid of the surgery can accept worse function level).

This correlation was not found in the control group.

Conclusions: Fear of surgery is an important factor in patients` unwillingness to undergo knee or hip arthroplasty, despite significant disability.

Preoperative psychological evaluation and care may help these patients to make more rational decisions.