Fatigue after major joint arthroplasty: relationship to preoperative fatigue and postoperative emotional state.

Fatigue has been widely assumed to increase after major surgery, and possible physical explanations have been intensively investigated. Nevertheless, existing data are almost exclusively from abdominal surgery and are based on the use of a single visual analogue scale. Moreover, no physical basis has been found. The present study used a more homogeneous surgical model than has been employed hitherto in order to find whether fatigue was related to emotional state. We measured fatigue before and 1 and 7 weeks after major joint arthroplasty in 63 patients, using a questionnaire that separates mental and physical fatigue. Physical function and subjective emotional and somatic state were measured at the same times; optimism was measured preoperatively. Neither mental nor physical fatigue increased after this form of surgery. Mental and physical fatigue each correlated with low positive mood throughout. The best predictor of physical fatigue postoperatively and at follow-up was preoperative physical fatigue. Preoperative mental fatigue and negative mood were independent predictors of mental fatigue postoperatively and at follow-up. Preoperative fatigue also predicted worse subjective emotional and physical state after surgery. These results suggest that fatigue should be regarded as an aspect of emotional distress perioperatively and that complaints of fatigue postoperatively may reflect the tendency to complain of fatigue or negative mood preoperatively rather than being attributable to surgical trauma.

Short-term recovery from hip and knee arthroplasty.

There are many studies of long-term recovery from major point arthroplasty, but little is known about the first days and weeks after operation. We measured function, emotional state and life evaluation before arthroplasty and at seven and 50 days after in a consecutive series of 40 hip and 23 knee replacements. Pain was relieved significantly at seven days after hip arthroplasty and even more at 50 days. In knee patients, pain relief was modest and was not apparent until 50 days. Functional ability was much improved by 50 days in hip patients, but hardly changed in knee patients. Positive mood and life satisfaction did not improve in either group. Our findings will help with more accurate information for patients before operation and also in judging the rate of recovery.