Background: Joint replacement surgery has emerged as a transformative solution for patients with advanced arthritis. However, awareness surrounding surgical indications, post-operative rehabilitation, and realistic expectations remains insufficient in many rural and semi-urban populations. This study assesses the knowledge, perceptions, and rehabilitation awareness among arthritis patients in Kangra district. Materials and Methods: A descriptive cross-sectional study was conducted between January and March 2025 involving 400 arthritis patients aged 45 years and above in Kangra. A validated bilingual questionnaire assessed socio-demographic factors, knowledge of joint replacement indications, surgical outcomes, rehabilitation processes, and myths. Knowledge scores were classified as Very Good (≥80%), Good (60–79%), Fair (41–59%), and Poor (<40%). Statistical significance was tested using chi-square analysis. Results: Of 400 respondents, 61.5% demonstrated good or very good awareness of joint replacement surgery. While 75.2% understood that the procedure alleviates pain and restores mobility, only 47.6% were aware of the importance of physiotherapy in recovery. Rural patients and those with lower education levels had significantly lower knowledge scores. Conclusion: Although awareness of joint replacement as a surgical option exists among arthritis patients in Kangra, major gaps remain in understanding post-surgical rehabilitation and long-term joint care. Patient education, particularly through primary care and orthopedic outreach, is critical to improving surgical outcomes and quality of life.
Arthritis, particularly osteoarthritis and rheumatoid arthritis, is a growing cause of chronic pain and disability, especially among the aging population. As conservative treatments lose effectiveness in advanced stages, joint replacement surgery becomes a vital option to restore function and improve quality of life. Knee and hip replacements, in particular, have shown to offer substantial benefits when appropriately timed and managed [1,2].
Despite the increasing prevalence of joint replacement procedures globally, many patients-especially in rural or under-resourced areas-remain unaware of the surgical indications, benefits, and post-operative requirements. A lack of knowledge leads to delays in decision-making, poor adherence to physiotherapy protocols, and unrealistic expectations from surgery [3,4].
In Kangra district of Himachal Pradesh, arthritis is commonly reported, yet perceptions around joint surgery are shaped by anecdotal experiences and cultural beliefs. Fear of surgery, misinformation about implant longevity, and underutilization of rehabilitation services continue to hinder optimal patient outcomes.
This study investigates the awareness levels of arthritis patients regarding joint replacement surgery and associated rehabilitation protocols. By identifying knowledge gaps, this research aims to promote patient-centric orthopedic education and enable better decision-making in managing chronic joint disorders.
Study Design
A community-based descriptive cross-sectional study.
Study Population
Arthritis patients aged 45 years and above, attending outpatient clinics and orthopedic camps in Kangra.
Study Duration
January to March 2025
Sample Size and Sampling
400 participants were recruited using purposive sampling from district hospitals, rural health centers, and mobile orthopedic camps.
Inclusion Criteria
Diagnosed with osteoarthritis or rheumatoid arthritis
Aged ≥45 years
Resident of Kangra district
Provided informed consent
Exclusion Criteria
History of cognitive impairment
Previous joint replacement surgery
Incomplete questionnaire data
Data Collection Tool
A bilingual structured questionnaire was developed in consultation with orthopedic and rehabilitation experts. It consisted of:
Socio-demographic profile
Twenty MCQs on joint replacement indications, surgical process, risks, outcomes, and rehabilitation
Behavior towards physiotherapy and follow-up care
Scoring and Classification
One point per correct answer. Scores classified as:
Very Good: ≥80%
Good: 60–79%
Fair: 41–59%
Poor: <40%
Data Analysis
Data were entered in MS Excel and analyzed using SPSS v26. Descriptive statistics summarized findings. Associations between socio-demographic variables and knowledge levels were evaluated using chi-square tests (p<0.05 considered significant).
Ethical Considerations
Ethical approval was obtained from the Ethics Committee. Written consent was taken from all participants.
The study participants were mostly from rural backgrounds and included more females than males, reflecting known demographics of arthritis burden. Educational levels were generally low, with only 13.5% having higher education-underscoring the potential influence of education on health literacy and awareness regarding complex procedures like joint replacement.
Table 1: Socio-Demographic Profile of Participants (N=400)
Variable | Category | Frequency (n) | Percentage |
Age Group | 45–54 | 122 | 30.5 |
55–64 | 176 | 44.0 | |
65 and above | 102 | 25.5 | |
Gender | Male | 183 | 45.8 |
Female | 217 | 54.2 | |
Education Level | Illiterate | 98 | 24.5 |
Primary | 132 | 33.0 | |
Secondary | 116 | 29.0 | |
Graduate and above | 54 | 13.5 | |
Residence | Urban | 174 | 43.5 |
Rural | 226 | 56.5 |
While most respondents understood the goal of joint replacement and commonly involved joints, critical gaps emerged in their understanding of recovery practices like physiotherapy, follow-up visits, and realistic expectations post-surgery. Knowledge around rehab and cost coverage was particularly low, indicating the need for clearer pre-surgical counseling and community-level orthopedic education.
Table 2: Knowledge Questions on Joint Replacement and Rehabilitation (N=400)
No. | Question | Options | Correct Answer | Correct |
1 | What is the primary purpose of joint replacement? | a) Weight loss, b) Pain relief and mobility, c) Muscle gain, d) Infection control | b | 75.2% |
2 | Which joints are most commonly replaced? | a) Elbow & wrist, b) Hip & knee, c) Neck & shoulder, d) Finger & ankle | b | 71.5% |
3 | Who is eligible for joint replacement? | a) Only athletes, b) Everyone, c) Patients with severe joint damage, d) Teenagers | c | 68.4% |
4 | What is a key component of recovery post-surgery? | a) Bed rest only, b) Massage, c) Physiotherapy, d) Reoperation | c | 47.6% |
5 | Does joint replacement cure arthritis permanently? | a) No, b) Yes, c) Sometimes, d) Depends on age | a | 56.9% |
6 | What is the average lifespan of a knee implant? | a) 5 years, b) 10 years, c) 15–20 years, d) Lifetime | c | 52.3% |
7 | Can joint replacement be delayed indefinitely? | a) Always, b) No, delays worsen condition, c) Yes, if pain is mild, d) Delay has no effect | b | 49.1% |
8 | What is a common risk after surgery? | a) Diabetes, b) Infection, c) Blood pressure, d) Cataract | b | 60.8% |
9 | Which professional supervises rehab after surgery? | a) Nurse, b) Surgeon, c) Physiotherapist, d) Patient | c | 53.0% |
10 | What is NOT advised post-surgery? | a) Light walking, b) Smoking, c) Balanced diet, d) Exercises | b | 66.3% |
11 | Ideal age group for joint replacement? | a) 20–30, b) 50–70, c) 10–20, d) 80+ | b | 59.7% |
12 | How long does full recovery usually take? | a) 3 days, b) 2 weeks, c) 3–6 months, d) 1 year | c | 50.5% |
13 | Can implants break with excessive strain? | a) Yes, b) No, c) Never, d) Only old models | a | 61.4% |
14 | Role of follow-up visits after surgery? | a) Optional, b) Essential, c) Wasteful, d) Emergency only | b | 62.9% |
15 | Joint replacement cost is covered by? | a) Always free, b) Never covered, c) Some insurance/government schemes, d) Not applicable | c | 45.2% |
16 | Myths: You can't walk after surgery? | a) True, b) False, c) Not sure, d) Depends | b | 63.1% |
17 | Joint replacement is done under? | a) Local anesthesia, b) General/spinal anesthesia, c) Without anesthesia, d) Sedation only | b | 57.8% |
18 | Is pain normal after surgery? | a) Never, b) Rarely, c) Yes initially, d) Constant | c | 60.2% |
19 | Are all patients satisfied after surgery? | a) Yes, b) Most but not all, c) No, d) None | b | 58.7% |
20 | What improves surgery outcome the most? | a) Luck, b) Doctor’s mood, c) Early rehab & adherence, d) Surgery cost | c | 54.6% |
Nearly two-thirds of participants scored in the good to very good range, showing general awareness of joint replacement basics. However, with 38.5% falling into the fair or poor categories, there remains a substantial need for structured, accessible patient education-especially on the postoperative and long-term care components of joint surgery.
Table 3: Knowledge Score Classification (N=400)
Knowledge Level | Score Range | Frequency (n) | Percentage (%) |
Very Good | ≥80% | 104 | 26.0% |
Good | 60–79% | 142 | 35.5% |
Fair | 41–59% | 108 | 27.0% |
Poor | <40% | 46 | 11.5% |
The results of this study provide a nuanced understanding of arthritis patients’ awareness regarding joint replacement surgery and rehabilitation in Kangra district. Encouragingly, a majority of participants were aware of the primary goal of joint replacement-relief from pain and improved mobility and could identify the commonly replaced joints. However, deeper insights reveal a critical disconnect between surgical awareness and knowledge of postoperative care.
One of the key areas of concern was the limited understanding of physiotherapy's essential role in recovery. Despite surgery being widely recognized as a pathway to restore joint function, less than half of the participants knew that active rehabilitation through guided physiotherapy determines the success of the procedure. This lack of awareness is likely to contribute to slower recovery, dissatisfaction, and avoidable complications.
Participants also showed uncertainty about implant durability, the timeline for recovery, and the importance of adherence to follow-up schedules. Such knowledge gaps can lead to unrealistic expectations and under-preparedness post-surgery. For instance, a considerable number of patients believed that surgery permanently cures arthritis, whereas in reality, it addresses joint damage but requires ongoing care [5,6].
Education level and residence played a significant role in knowledge scores. Rural participants and those with lower education levels were consistently less informed. This suggests that awareness campaigns and orthopedic outreach must prioritize these communities. Strategies could include visual aids, multilingual counseling, and integration of joint care education into community health worker training [7,8].
It is equally important to address prevalent myths-such as the belief that one cannot walk after surgery or that joint replacement is unsafe for older adults. These misconceptions can discourage patients from timely intervention, thereby diminishing quality of life. By equipping primary care providers and orthopedic teams with simplified educational tools, patients can be empowered to make informed decisions and adhere to rehabilitation.
This study reveals that while arthritis patients in Kangra are somewhat familiar with the concept of joint replacement, their understanding of the full surgical journey-including risks, recovery expectations, and rehabilitation-is limited. These knowledge gaps are more prominent among rural and less-educated populations. Addressing them through structured patient education, pre-operative counseling, and accessible rehabilitation services will be crucial in enhancing surgical outcomes and patient satisfaction in joint care across the region.
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