Simulation-Based Preoperative Education in Total Knee Arthroplasty

Total knee arthroplasty is a major orthopedic surgical procedure that may lead to significant physical and psychological challenges for patients during the perioperative period. In addition to postoperative pain and functional limitations, patients frequently experience surgical fear and fear of movement (kinesiophobia), which may negatively affect early mobilization and recovery. Preoperative education is considered an essential nursing intervention to support patients in coping with these challenges; however, the optimal method for delivering such education remains an area of ongoing research.

Simulation-based education has increasingly been used in healthcare education to enhance understanding, reduce uncertainty, and improve preparedness by allowing individuals to actively engage with the anticipated care process. While its effectiveness has been well documented in student education, evidence regarding its use in preoperative patient education, particularly in orthopedic surgery, is limited.

This randomized controlled trial aims to examine the effect of simulation-based preoperative education on surgical fear and kinesiophobia in patients undergoing primary total knee arthroplasty. Eligible patients are randomly assigned to either an intervention group receiving simulation-based preoperative education or a control group receiving standard verbal preoperative education according to institutional routine practice. The educational intervention is delivered one day prior to surgery.

Data are collected using validated instruments, including the Surgical Fear Questionnaire, the Tampa Scale of Kinesiophobia, and the Visual Analog Scale for pain assessment. Surgical fear is assessed during the preoperative period, while kinesiophobia and postoperative pain are evaluated following surgery during the early mobilization phase.

The results of this study are expected to provide evidence to inform nursing-led preoperative education strategies and to support the development of patient-centered approaches aimed at improving psychological preparedness and postoperative recovery in individuals undergoing total knee arthroplasty.

Inclusion criteria

• Aged 18 years and older
• Scheduled for primary total knee arthroplasty
• Able to communicate and cooperate
• Able to speak and understand Turkish
• No diagnosed major psychiatric disorder
• No diagnosed neurological disorder
• Willing to participate and able to provide written informed consent

Exclusion criteria

• Revision total knee arthroplasty
• Bilateral total knee arthroplasty
• Total knee arthroplasty performed due to trauma
• Presence of neurological, traumatic, or systemic conditions that may limit mobility
• Development of postoperative surgical or prosthesis-related complications
• Development of any condition preventing postoperative mobilization