title: The hip and knee replacement operation: an extensive life event.
abstract: BACKGROUND
  A total hip replacement and a total knee replacement have shown to effectively reduce pain and disability in patients with osteoarthritis of the hip and knee joint despite associated risks. Even though the intervention primarily concerns older people with additional health problems, the patients stand on their feet the day after the operation and are discharged a few days later. Previous research indicates that reflections about life are related to the operation.
  
  
  OBJECTIVE
  The aim of this study was to illuminate the meaning of reflections related to hip and knee replacement surgery.
  
  
  METHODS
  A phenomenological hermeneutical approach with a longitudinal design was chosen in order to study the participants' experiences of the hip and knee replacement intervention across the entire perioperative period.
  
  
  RESULTS
  Four themes emerged from the structural analysis; choosing the challenge, past memories connect to the current situation, moving from happiness to ordinary everyday life and moving from despair towards reluctant acceptance of unexpected bad conditions for everyday life. There was inner negotiations about having surgery or not, and existential anxiety that reminded people that life cannot be taken for granted.
  
  
  CONCLUSIONS
  Our findings indicate the operation was seen as an extensive life event including reflections about life and death and about hope and fear. Previous bad experiences of care seemed to influence the way patients dealt with fear and hope. Fear had to be overcome by inner negotiations about undergoing surgery or not. Relief was expressed about surviving the actual operation, but soon after fears arose about how to manage on the actual road to recovery. Hope for a good life grew either stronger or weaker, depending on the progress following the operation. The outcome eventually generated a transition from happiness to ordinary everyday life, or a transition from despair towards reluctant acceptance of unfulfilled expectations.
authors.affiliation: Department of Neurobiology, Caring Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden. birgitta.a.gustafsson@ki.se
authors.forename: Birgitta Åkesdotter
authors.initials: BÅ
authors.lastname: Gustafsson
authors.forename: Sirkka-Liisa
authors.initials: SL
authors.lastname: Ekman
authors.forename: Sari
authors.initials: S
authors.lastname: Ponzer
authors.forename: Kristiina
authors.initials: K
authors.lastname: Heikkilä
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D008016:Life Change Events