[Role of subjective clinical aspects through the evaluation of patients' satisfaction with total arthroplasty of the hip]. / Rôle des éléments cliniques subjectifs pour l'évaluation de la satisfaction des patients après arthroplastie totale de la hanche.

The purpose of this study was to detect subjective elements that came into play with the satisfaction of patients that had been undergoing total hip replacement surgery. None of the patients had ever had a psychiatric pathology or undergone orthopedic surgery before. We defined specific questionnaires in order to support this study, based upon a clinical experience very representative of daily practice. In this study, we have also included the summary of clinical notes which highlight one of the present roles of a psychiatrist in a field which is no longer strictly psychiatric disease. Working daily with surgeons gave us access to patients who do not belong to traditional psychiatry but who need carefully selected words and not only a surgical operation in order to become really relieved. This work demonstrated that the standard quality-of-life questionnaires did not allow to evaluate patients' subjective assessments. In order to take into account this subjectivity, it was necessary to combine questionnaires and open-ended interviews. The analysis of the data gathered in this study showed that half of the patients underwent, roughly 3 months after surgery, a period of temporary frustration, although the hip was already in very good condition, according to objective measures. Patients could get out of this temporary period of disappointment--which seemed to be a necessary stage of mourning of their complaint--without any specific treatment. But a good relationship between surgeon and patient was necessary; it helped the patient and the surgeon to escape a duel or a confrontation. For some patients it may have taken as long as one year to enjoy all the benefits of the operation.