Home > Aging > Knee surgery? Don’t forget the boombox.

Knee surgery? Don’t forget the boombox.

When I was a kid, my dad’s mom was always the sharpest, most pointedly funny person at our family gatherings. She was smart and witty, and also incredibly independent, living alone in a split-level house and always baking things to bring to our parties (even if everything she made tasted like cigarettes). When she was in her late 70s, however, she fell in the house and broke her hip, leading to a surgery and fairly lengthy hospital stay. We visited several times during her hospitalization, and I remember that even as a kid I could tell something wasn’t right. My grandmother wasn’t her normal self – she seemed like she was processing slower, and she sometimes became confused about what was happening, which I had never seen happen to her.

As it turns out, this is a common after-effect of hip and knee surgery in older adults. There is a fairly high risk of cognitive impairment following these types of surgeries, with 30% to 50% of patients experiencing what is referred to as “acute confusion”, characterized by the older adults appearing confused, disoriented, and unable to interact with others. There are a number of contributing factors, ranging from the anesthesia to the physical discomfort to the stress of hospitalization. Obviously, these types of effects can be incredibly distressing for both the patient and their caregivers, especially when, as in my grandmother’s case, the patient was cognitively healthy going into surgery. While many people recover from these effects fairly quickly, there can sometimes be a lengthy period of carryover, and about half of the patients who experience acute confusion in the hospital are still dealing with disorientation anywhere from 2-12 months after surgery. This is why it is so crucial to find ways of reducing post-op acute confusion, so Dr. Ruth McCaffrey has been exploring how music can be used as a tool to promote healthy cognitive function in older adults after hip or knee surgery.

Prior to McCaffrey’s study (2009), music had already been shown to help older adults by reducing anxiety and agitation (Hicks-Moore, 2005; McKinney, 1997), which are both associated with acute confusion. McCaffrey (2009) was specifically interested in how music could impact the level of cognitive functioning as well as the amount of acute confusion, the disorientation I explained above, in older patients following hip or knee surgery. Her hope was that providing music might decrease the instances of acute confusion in older adults, which would lead to better cognitive healing. She enlisted 22 older patients on their preoperative visit and evaluated each of them using two scales, one that measures cognitive function (MMSE) and one that measures the presence of acute confusion (NEECHAM). After surgery, the control group was given the standard post-op care (meaning no music, but the same care as the experimental group in every other respect), and the experimental group additionally received CD players to keep by their beds and a large selection of CDs to choose from, ranging from Barbara Streisand to Celtic guitar to nature sounds of the Caribbean. During each of the three post-op days, patients in the music condition were asked to listen to the provided music at least four times a day for an hour (although they were welcome to listen to it for longer if they wanted), and all of the participants’ mental progress was measured daily using the MMSE and NEECHAM. The MMSE is presented to the patient as a short questionnaire consisting of questions like “What town are we in?” and tasks such as “Spell WORLD backwards”. The NEECHAM, on the other hand, is an inventory that can be completed by the nurse as she or he checks the patient’s vitals, and the patient is graded on items such as his or her general attention, ability to follow a simple command, appearance, and motor behavior.

McCaffrey found that the simple act of providing patients with music yielded impressive results. The experimental group exhibited less cognitive decline after surgery than did the control group, which means that music was helping them to return to normal cognitive functioning faster than they might have otherwise. They also experienced significantly less acute confusion than the control group across the post-op period. These results are something the medical world should pay attention to because they demonstrate that something as cheap and accessible as a music source can have a huge positive impact on the experience of hip and knee surgery patients. We aren’t talking about an expensive medication or a time-consuming therapy – it’s just music.

I can’t help but wonder what positive effects music might have held for my grandmother when she was hospitalized. Maybe, if she’d had a CD player by her bed, she’d have been her normal, sharp-witted self, making sassy comments about the nurses and demanding that someone bring her a smoke.


Hicks-Moore, S. (2005). Relaxing music at mealtimes in nursing homes: Effect on agitated patients with dementia. Journal of Gerontological Nursing, 31(12), 26-32.

McCaffrey, R.G.(2009). The effect of music on the cognition of older adults undergoing hip and knee surgery. Music and Medicine, 1(1), 22-28.

McKinney, J. (1997). Current awareness in geriatric psychiatry. International Journal of Geriatric Psychiatry, 18(4), 365-372.


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  1. Samuel Poulin
    December 2nd, 2013 at 10:04 | #1

    It’s amazing how many cheap, non-invasive strategies there are to improve the daily lives of older adults. They’re often times much more effective than drugs, minus the side effects. As another example that I’ll post later today, Alzheimer’s patients who have the opportunity to interact with dogs often display fewer behavioral problems that would otherwise be managed with heavy doses of medication. It’s unfortunate that these methods aren’t more widely used, but encouraging that recent research efforts are increasingly becoming more devoted to these supplemental treatments. My Great Aunt also had a hip replacement a few years ago, and her behavioral shifts were significant and noticeable. Fortunately this didn’t persist for too long after her surgery, but it’d be nice to know that in the future, these methods might be used so that post-op hospital stays can be made a little more pleasant for patients.

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