Background/Purpose: Patients who undergo total knee replacement (TKR) and total hip replacement (THR) need significant help in the immediate post-operative period, when discharged to home. Limited or no data are available regarding the impact of family support on short and intermediate term pain and function outcomes after THR or TKR.  

Methods: A subset of patients from a national joint registry undergoing primary TJR between 5/2013 and 6/2014 were queried patients at 2- and 8-weeks regarding pain severity and level of family support, assessed with validated single-item (0-10; 10=highest family support) and dichotomized, as previously into deficient (scores 5 or less) or non-deficient family support (6-10). Frequency distributions were used to describe the cohort; bivariate statistical tests to compare groups included the chi-square, Fisher’s exact, t tests and Wilcoxon-Mann-Whitney test.

Results: There were 1,502 primary TKR or primary THR respondents at 2-weeks and 1,514 respondents at 8-weeks. 1416 patients reported good level of family support and 86 reported deficient family support (level 5 or less; 5.7%) on the 2-week survey; 1,418 reported good family support 96 reported deficient family support (6.3%) on the 8 week survey.  Patients with higher family support were older (66.4 vs. 63.0), more likely to be males (41% vs. 31%), and less likely to have income <45K (25% vs. 43%).

At 2-weeks, compared to patients with non-deficient family support (scores 6-10), those with deficient family support had significantly higher levels of pain severity (3.9 vs. 3.2), pain frequency (4.6 vs. 3.2) and lower levels of satisfaction with pain control (0.68 vs. 0.83), treatment satisfaction (5.6 vs. 6.0) and participation in decision-making (6.9 vs. 8.1).  At 8-weeks, similar differences were noted: significantly higher levels of pain severity (2.5 vs. 1.8), pain frequency (4.4 vs. 2.9); and lower levels of current satisfaction with pain control (0.71 vs. 0.83), treatment satisfaction (5.4 vs. 6.0) and participation in decision making (6.9 vs. 8.4).

Conclusion: To our knowledge, this is the first study examining the association of family support with pain and other outcomes after TKR and THR. A positive association of non-deficient family support with better pain and satisfaction outcomes is a novel finding.  Further research into how to translate these findings into improved outcomes after TKR/THR for those with deficient family support are needed.