# Stairway to heaven via the highway to hell: a qualitative study on patients’ experience of knee joint replacement surgery

## TL;DR

This study explores the experiences of patients who had knee replacement surgery in Sweden, highlighting the importance of pre-operative information and support for better outcomes.

## Contribution

The study provides new qualitative insights into patient experiences and care pathways in knee replacement surgery in Sweden.

## Key findings

- Patients often lacked pre-operative information about pain and mental well-being.
- Patients generally felt satisfied with their decision to undergo surgery despite challenges.
- Improved pre-operative information and holistic support could enhance patient outcomes.

## Abstract

Knee replacement (KR) is the most common osteoarthritis (OA) related surgery. Studies suggest that there are major international and national disparities in pre-operative information, support and access to rehabilitation which have a substantial impact on patients’ perceived outcomes of the KR. The aim of this qualitative study was to explore experiences and perceptions of the care pathway in patients who have undergone KR and subsequent rehabilitation in Sweden.

Four focus group discussions were performed including in total 25 patients (16 women), median age 67.5 (range) (46–81 years), 1 to 15 months after KR. The discussion recordings were transcribed verbatim and were analysed qualitatively using content analysis with an inductive approach.

The analysis resulted in four categories: (1) The crooked road towards surgery, (2) Needing support throughout the whole journey, (3) Feelings of psychological distress and (4) A balancing act towards a new life. A lack of pre-operative information regarding expected pain, need of support and mental well-being were described. Although the journey was sometimes tough, patients’ expectations were, however, often fulfilled and they were in general satisfied with the decision to undergo surgery.

Some of the challenges identified in this study may be alleviated by sufficient pre-operative information covering realistic expectations on surgery outcomes and mental aspects as well as emphatic and holistic support by healthcare providers. The result of this study will aid in the development and implementation of a national clinical practice guideline to ensure patient-centered care throughout the KR care pathway.

The online version contains supplementary material available at 10.1186/s13018-025-05989-5.