Discussion
TKA, anxiety, pain
The aim of this study was to evaluate the intraoperatively recorded video’s potential on the early outcome after TKA. The hypothesis was that this intraoperative video material would increase confidence in the operated knee and allow patients to perform better in the immediate postoperative phase with respect to the ROM and clinical outcome parameters. We found that the showing of an intraoperatively recorded video illustrating ROM had no effect on ROM and clinical outcome at 6 weeks and that both groups showed significant improvements in clinical scores.The theoretical concept of the study design was “seeing is believing”. The study aimed to improve the postoperative ROM and clinical scores by showing patients their actual potential of knee movement and stability. There are no other studies that look at postoperative education and its effect on outcome like this one. The participants who have been shown a video should be encouraged to participate more actively and enthusiastically immediately postoperatively. The patients should be given a feeling of safety and trust in the prosthesis as anxiety is a known negative predictor of unsatisfactory results after joint replacement [In TKA patients, recovery starts immediately after surgery. Besides preoperative education, postoperative care is crucial for achieving a favorable outcome [The follow-up period was limited to 6 weeks to minimize other factors that influence the outcome, although we recognize that improvement of TKA may extend well beyond this period. The first 6 weeks are relatively comparable for all patients. Usually, our patients start with outpatient post-surgical rehabilitation on the day of discharge. After 6–10 weeks, some patients go to inpatient rehabilitation, and some continue with outpatient physiotherapy. The rest is already so satisfied or independent after 6 weeks that no further professional therapy is needed. Before the study began, we did not expect a measurable or clinically relevant effect of the video beyond 6 weeks.Surprisingly, after 6 weeks, the ROM had not yet reached the preoperative status. This may be related to the fact that due to the corona pandemic restrictions, the nKSS of six patients from the video group and five patients from the control group had to be assessed by telephone. It is possible that these patients underreported their ROM, although TKA patients are usually very familiar with the degrees of flexion, as they are monitored by this method from the first postoperative day. The outpatient follow-up of these 11 patients could only take place later.We want to outline the following limitation of our work: The clinical outcome and ROM as the endpoints of this analysis were evaluated only within a short follow-up period of 6 weeks and long-term data cannot be presented at this point. In addition, it might have been an option to collect data on pain medication, length of hospital stay, and other endpoints to detect potential short-term benefits in the control group. Normally, inter- and intra-class calculations are performed with a break of 2 weeks in between, which was not possible due to the chance of ROM improvement within this time period. However, we also want to emphasize the benefit that this is a randomized, controlled, prospective trial with an a priori power analysis and sample size calculation. The fact that we observed no clinically relevant differences between groups does not impair the scientific methodology, as we performed an adequate power analysis, but further strengthens the relevance of the publication of these results due to a potential file-drawer bias if negative outcome studies are not published [