Overview
Many patients feel anxious before joint replacement surgery. This anxiety is common - affecting roughly 1 in 3 patients - and research has shown that patients who are more anxious before surgery tend to have more pain afterward and may need more pain medication during recovery. Listening to music before medical procedures has been shown to reduce anxiety in many types of surgery. In fact, a recent analysis of 20 studies found that music works about as well as anti-anxiety medication for calming patients before surgery, with about 1 in 4 patients experiencing a meaningful benefit. However, almost all of this research has been done in other types of surgery. No study has specifically tested whether letting patients listen to their own preferred music before hip or knee replacement surgery reduces their anxiety.
This study will randomly assign 52 patients scheduled for hip or knee replacement surgery to one of two groups: one group will listen to music of their choice through noise-cancelling headphones while waiting for surgery (for at least 20 minutes), and the other group will receive the usual preoperative care without music. Patients will fill out a brief 6-question anxiety survey when they arrive in the preoperative area and again just before being taken to the operating room. The study will also ask patients about their pain, anxiety, and overall experience after surgery, and will review their medical charts to see how much sedation and pain medication was used during the procedure. If music is shown to reduce anxiety in this setting, it could be easily adopted by any hospital at very low cost, offering patients a simple, drug-free way to feel calmer before their surgery.
Description
Preoperative anxiety affects 20-33% of patients undergoing total joint arthroplasty (TJA) and is independently associated with worse postoperative pain, higher opioid consumption, and lower functional outcomes. Music intervention is a well-established non-pharmacologic anxiolytic, with meta-analytic evidence demonstrating a standardized mean difference (SMD) of 0.72 (95% CI 0.92 to 0.53) for perioperative anxiety reduction using validated instruments, corresponding to a number needed to treat (NNT) of 4. However, the evidence base derives predominantly from general surgical populations. The only systematic review specific to hip and knee surgery identified just 10 studies of mixed quality and explicitly called for larger, well-designed randomized controlled trials (RCTs) in this population. No RCT has examined patient-preferred preoperative music specifically in TJA patients undergoing spinal anesthesia.
Objective: To determine whether patient-preferred music delivered via noise-cancelling headphones during the preoperative holding period reduces acute preoperative anxiety in patients undergoing primary total hip arthroplasty (THA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) under spinal anesthesia.
Methods: This is a prospective, single-center, two-arm, parallel-group RCT. Fifty-two patients (26 per group) undergoing primary THA, TKA, or UKA for osteoarthritis under spinal anesthesia will be randomized 1:1 to either (1) standard preoperative care plus patient-preferred music via Bose QuietComfort noise-cancelling headphones (minimum 20 minutes, continuing until OR transport) or (2) standard preoperative care alone. The primary outcome is the change in prorated STAI-6 score (20-80 scale) from arrival in the preoperative holding area (T1) to immediately before OR transport (T2). Secondary outcomes include postoperative anxiety (NRS 0-10), pain (NRS 0-10), global surgical experience (NRS 0-10), and intraoperative sensory recall. Exploratory chart-review outcomes include total sedation and intraoperative opioid consumption.
Significance: This study addresses a gap explicitly identified in the literature by providing the first RCT of patient-preferred preoperative music in TJA patients under spinal anesthesia. If effective, the intervention is immediately implementable at negligible cost and could reduce reliance on pharmacologic anxiolytics in the preoperative setting.
Eligibility
Inclusion Criteria:
- Adults 18 years or older undergoing primary THA, TKA, or UKA for osteoarthritis
- Planned spinal/regional anesthesia
- Willingness to undergo randomization
- Ability to provide informed consent in English
Exclusion Criteria:
- Chronic opioid use prior to surgery
- Revision TJA
- Primary diagnosis other than osteoarthritis (e.g., fracture, posttraumatic arthritis, AVN)
- Hearing impairment precluding music listening
- Active psychiatric disorder requiring current pharmacotherapy
- Pregnancy
- Inability to provide informed consent in English
