Patient Experiences Following Total Knee Arthroplasty in Peshawar, Pakistan: A Qualitative Thematic Analysis
DOI:
https://doi.org/10.37762/jgmds.13-2.832Keywords:
Total Knee Arthroplasty, Patient Experience, Pakistan, Qualitative Research, Rehabilitation AccessAbstract
ABSTRACT
OBJECTIVES
This study aimed to explore the psychosocial, cultural, and economic factors that influence the decision to undergo TKA and the postoperative recovery process in a resource-limited context.
METHODOLOGY
A qualitative descriptive study was conducted using semi-structured interviews with 31 patients (16 females, 15 males; aged 48-82 years) recruited from public and private hospitals between January and May 2025. Data were analyzed using Braun and Clarke’s reflexive thematic analysis framework. Data saturation was achieved after 31 interviews.
RESULTS
Five overarching themes emerged: 1. preoperative suffering and fear, 2. hospital experience amid systemic constraints, 3. inequities in postoperative rehabilitation, 4. cultural and financial determinants, and 5. transformative outcomes post-surgery. Delayed surgical decision-making, reliance on traditional healing (55%), and significant financial burden (79% catastrophic expenditure) were prominent findings.
CONCLUSION
TKA in Peshawar involves a complex biopsychosocial journey, shaped by cultural norms, economic hardship, and limitations in the health system. Addressing disparities in rehabilitation access and financial protection is critical to optimizing outcomes.
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Scanlon CM, Sun DQ, Alvarez AM, Webb ML, Perez BA, Yu AS, et al. Alignment errors and revision risk in kinematically aligned total knee arthroplasty. J Arthroplasty. 2020;35(11):3166-3171. https://doi.org/10.1016/j.arth.2020.06.029 PMID: 32712088 DOI: https://doi.org/10.1016/j.arth.2020.06.029
Jacobson AF, Myerscough RP, Delambo K, et al. Patients’ perspectives on total knee replacement. Am J Nurs. 2008;108(5):54-63. PMID: 18497514 DOI: https://doi.org/10.1097/01.NAJ.0000318000.62786.fb
Ballantyne PJ, Williams S, Hovell J. Patients’ perceptions of total knee replacement outcomes. Arthritis Rheum. 2007;57(1):27-34. https://doi.org/10.1002/art.22422 PMID: 17266066 DOI: https://doi.org/10.1002/art.22472
Hawker GA. Who, when, and why total joint replacement surgery? Curr Opin Rheumatol. 2006;18(5):526-530. https://doi.org/10.1097/01.bor.0000240367.49164.0e PMID: 16896291 DOI: https://doi.org/10.1097/01.bor.0000240367.62583.51
Lim PB, Sauder N, Peterson SL, Melnic CM, Bedair HS. Minimal clinically important difference and revision risk following total knee arthroplasty. Arch Orthop Trauma Surg. 2025;145:482. https://doi.org/10.1007/s00402-025-06068-4 DOI: https://doi.org/10.1007/s00402-025-06068-4
Arias-De La Torre J, Smith K, Dregan A, Valderas JM, Evans JP, Prieto-Alhambra D, et al. Impact of comorbidity on revision risk after total knee arthroplasty. BMC Musculoskelet Disord. 2020;21:1-9. https://doi.org/10.1186/s12891-020-03455-3 PMID: 32646444 DOI: https://doi.org/10.1186/s12891-020-03455-3
Cregar WM, Khazi ZM, Lu Y, Forsythe B, Gerlinger TL. Arthrofibrosis after TKA and risk of revision surgery. J Arthroplasty. 2021;36(1):339-344. https://doi.org/10.1016/j.arth.2020.07.018 PMID: 32861715 DOI: https://doi.org/10.1016/j.arth.2020.07.018
McDonald S, Page MJ, Beringer K, et al. Preoperative education for hip or knee replacement. Cochrane Database Syst Rev. 2014;(5):CD003526. https://doi.org/10.1002/14651858.CD003526.pub3 PMID: 24820247 DOI: https://doi.org/10.1002/14651858.CD003526.pub3
Marcinkowski K, Wong VG, Dignam D. The experience of patients undergoing total knee arthroplasty. Orthop Nurs. 2005;24(3):202-209. PMID: 15942359 DOI: https://doi.org/10.1097/00006416-200505000-00009
Macario A, Schilling P, Rubio R, et al. What questions do patients undergoing joint replacement have? BMC Health Serv Res. 2003;3:11. https://doi.org/10.1186/1472-6963-3-11 PMID: 12952540 PMCID: PMC212731 DOI: https://doi.org/10.1186/1472-6963-3-11
Trousdale RT, McGrory BJ, Berry DJ, et al. Patients’ concerns prior to total knee arthroplasty. Mayo Clin Proc. 1999;74(10):978-982. https://doi.org/10.4065/74.10.978 PMID: 10918863 DOI: https://doi.org/10.4065/74.10.978
Hawker GA, Wright JG, Coyte PC, et al. Determining the need for joint replacement surgery. Med Care. 2001;39(3):206-216. PMID: 11242317 DOI: https://doi.org/10.1097/00005650-200103000-00002
Ackerman IN, Dieppe PA, March LM, et al. Variation in total knee arthroplasty utilization. Arthritis Rheum. 2007;57(7):1228-1236. https://doi.org/10.1002/art.22964 PMID: 17907236 DOI: https://doi.org/10.1002/art.22964
Ibrahim SA, Siminoff LA, Burant CJ, et al. Understanding ethnic disparities in total knee arthroplasty utilization. J Bone Joint Surg Am. 2002;84(12):216-220. PMID: 12473701
Duivenvoorden T, Vissers MM, Verhaar JA, et al. Anxiety and depression in patients undergoing total knee arthroplasty. Bone Joint J. 2013;95-B(4):508-514. https://doi.org/10.1302/0301-620X.95B4.30315 PMID: 23539700
Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical outcomes. BMJ Open. 2013;3:e001570. https://doi.org/10.1136/bmjopen-2012-001570 PMID: 23293244 PMCID: PMC3549241 DOI: https://doi.org/10.1136/bmjopen-2012-001570
Artz N, Elvers KT, Lowe CM, et al. Effectiveness of physiotherapy after total knee replacement: systematic review. BMC Musculoskelet Disord. 2015;16:15. https://doi.org/10.1186/s12891-015-0469-7 PMID: 25637361 PMCID: PMC4316705. DOI: https://doi.org/10.1186/s12891-015-0469-6
Minns Lowe CJ, Barker KL, Dewey ME, Sackley CM. Effectiveness of physiotherapy exercise following total knee replacement: randomized controlled trial. BMJ. 2007;335:812. https://doi.org/10.1136/bmj.39311.460093.BE PMID: 17959763 PMCID: PMC2047078 DOI: https://doi.org/10.1136/bmj.39311.460093.BE
Xu K, Evans DB, Kawabata K, et al. Household catastrophic health expenditure: a multicountry analysis. Lancet. 2003;362:111-117. https://doi.org/10.1016/S0140-6736(03)13861-5 PMID: 12867110 DOI: https://doi.org/10.1016/S0140-6736(03)13861-5
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Copyright (c) 2026 Muhammad Waqar, Samir Khan Kabir, Muhammad Arif, Wasim Anwar
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