Preoperative self-preparation for total knee arthroplasty is multifactorial and can be optimized by targeting external support and internal motivation

1. Pre-operative self-preparation for older adults undergoing total knee arthroplasty (TKA) is multifactorial and can be optimized by addressing patients’ physiological status, external support systems and their own internal motivation.

Evidence Rating Level: 3 (Average)

TKA is an important treatment for end-stage knee diseases, yet a significant amount of patients who undergo TKA report dissatisfaction following the procedure. Previous quantitative studies have shown that higher levels of pre-operative self-preparation are closely associated with greater post-operative satisfaction, yet did not provide insight into specific factors influencing these self-preparation behaviours. This descriptive qualitative study therefore sought to investigate factors influencing pre-operative self-preparation among older adults undergoing TKA. 16 adults aged 60 and older scheduled for a primary unilateral TKA from a medical centre in China underwent semi-structured interviews the day prior to their surgery. From these interviews, 3 common themes were identified. The first was that many patients had limited pre-operative self-preparation capabilities due to multimorbidity or lack of understanding of the procedural process. The second was that many patients lacked the necessary social environment and external support to enable adequate pre-operative self-preparation. Finally, the third was that many internal motivation for pre-operative self-preparation varied among patients. Overall, this study found that pre-operative self-preparation for older adults undergoing TKA was influenced by many different factors, with special attention required towards 3 common themes. 

Click here to read the study in BMJ Open

Citation: Sun J, Pei Y, Zhang X. Perceived factors shaping preoperative self-preparation among older patients undergoing total knee arthroplasty: a qualitative study. BMJ Open. 2026 Oct 5;16(10):e122819. doi: 10.1136/bmjopen-2026-122819. PMID: 42833713; PMCID: PMC13646955.

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