Abstract
Purpose
Patient-based and psychological factors do influence outcome in patients undergoing total knee arthroplasty (TKA). The purpose was to investigate if preoperative psychological factors influence the subjective and objective outcomes 6 weeks, 4 months and 1 year after TKA. Our hypothesis was that there is a significant influence of psychological factors on clinical outcome scores before and after TKA.
Methods
A prospective, longitudinal, single-cohort study investigating the correlation of depression, control beliefs, anxiety and a variety of other psychological factors with outcomes of patients undergoing TKA was performed. A total of 104 consecutive patients were investigated preoperatively using the Beck`s depression inventory, the State-Trait Anxiety Index, the questionnaire for assessment of control beliefs and the SCL-90R inventory. The Knee Society Clinical Rating System (KSS) and the WOMAC were used. Analysis of TKA position was performed on radiographs according to Ewald et al. Correlation of psychological variables with outcomes was performed (p < .05).
Results
Self-efficacy did not influence clinical scores. More depressed patients showed higher pre- and postoperative WOMAC scores, but no difference in amelioration. KSS scores were not influenced. Patients with higher State and Trait Anxiety Indexes had higher WOMAC and lower KSS scores before and after the operation, but most significant correlations were <0.3. Several SCL-90 dimensions had significant correlations with pre- and postoperative clinical scores, but not with their amelioration. The SCL-90 subscore for somatization and the overall SCL-90 significantly correlated with the WOMAC, KSS before and after TKA.
Conclusions
Depression, anxiety, a tendency to somatize and psychological distress were identified as significant predictors for poorer clinical outcomes before and/or after TKA. Standardized preoperative screening and subsequent treatment should become part of the preoperative work-up in orthopaedic practice.
Level of evidence
Prognostic prospective, Level I.
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References
Al-Hadithy N, Rozati H, Sewell MD, Dodds AL, Brooks P, Chatoo M (2012) Causes of a painful total knee arthroplasty. Are patients still receiving total knee arthroplasty for extrinsic pathologies? Int Orthop 36(6):1185–1189
Barclay-Goddard R, Epstein JD, Mayo NE (2009) Response shift: a brief overview and proposed research priorities. Qual Life Res 18(3):335–346
Beck AT, Steer RA (1984) Internal consistencies of the original and revised Beck depression inventory. J Clin Psychol 40(6):1365–1367
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571
Becker R, Doring C, Denecke A, Brosz M (2011) Expectation, satisfaction and clinical outcome of patients after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19(9):1433–1441
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840
Blackburn J, Qureshi A, Amirfeyz R, Bannister G (2012) Does preoperative anxiety and depression predict satisfaction after total knee replacement? Knee 19(5):522–524
Bonnin MP, Basiglini L, Archbold HA (2011) What are the factors of residual pain after uncomplicated TKA? Knee Surg Sports Traumatol Arthrosc 19(9):1411–1417
Brander V, Gondek S, Martin E, Stulberg SD (2007) Pain and depression influence outcome 5 years after knee replacement surgery. Clin Orthop Relat Res 464:21–26
Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, Houle T (2003) Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res 416:27–36
Brox JI, Storheim K, Grotle M, Tveito TH, Indahl A, Eriksen HR (2008) Systematic review of back schools, brief education, and fear-avoidance training for chronic low back pain. Spine J 8(6):948–958
Elson DW, Brenkel IJ (2006) Predicting pain after total knee arthroplasty. J Arthroplasty 21:1047–1053
Ewald FC (1989) The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12
Fehring TK, Christie MJ, Lavernia C, Mason JB, McAuley JP, MacDonald SJ, Springer BD (2008) Revision total knee arthroplasty: planning, management, and controversies. Instr Course Lect 57:341–363
Fisher DA, Dierckman B, Watts MR, Davis K (2007) Looks good but feels bad: factors that contribute to poor results after total knee arthroplasty. J Arthroplasty 22(6 Suppl 2):39–42
Derogatis LR, Lipman RS, Covi L (1973) SCL-90: an outpatient psychiatric rating scale preliminary report. Psychopharmacol Bull 9:13–28
Hirschmann MT, Iranpour F, Konala P, Kerner A, Rasch H, Cobb JP, Friederich NF (2010) A novel standardized algorithm for evaluating patients with painful total knee arthroplasty using combined single photon emission tomography and conventional computerized tomography. Knee Surg Sports Traumatol Arthrosc 18(7):939–944
Hirschmann MT, Konala P, Amsler F, Iranpour F, Friederich NF, Cobb JP (2011) The position and orientation of total knee replacement components: a comparison of conventional radiographs, transverse 2D-CT slices and 3D-CT reconstruction. J Bone Joint Surg Br 93(5):629–633
Hirschmann MT, Konala P, Iranpour F, Kerner A, Rasch H, Friederich NF (2011) Clinical value of SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty–a new dimension of diagnostics? BMC Musculoskelet Disord 12:36
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14
Laux LG, Schaffner P, Spielberger CD (1981) Das State-Trait-Angstinventar (STAI-G) Beltz Test GmbH, Weinheim
Lingard EA, Riddle DL (2007) Impact of psychological distress on pain and function following knee arthroplasty. J Bone Joint Surg Am 89(6):1161–1169
Lohaus A (1992) Kontrollüberzeugungen zu Gesundheit und Krankheit. Z Klein Psychol 21:76–87
Lopez-Olivo MA, Landon GC, Siff SJ, Edelstein D, Pak C, Kallen MA, Stanley M, Zhang H, Robinson KC, Suarez-Almazor ME (2011) Psychosocial determinants of outcomes in knee replacement. Ann Rheum Dis 70(10):1775–1781
Papakostidou I, Dailiana ZH, Papapolychroniou T, Liaropoulos L, Zintzaras E, Karachalios TS, Malizos KN (2012) Factors affecting the quality of life after total knee arthroplasties: a prospective study. BMC Musculoskelet Disord 13:116
Riddle DL, Wade JB, Jiranek WA (2010) Major depression, generalized anxiety disorder, and panic disorder in patients scheduled for knee arthroplasty. J Arthroplasty 25(4):581–588
Spielberger CG, Gorsuch RL, Lushene RE (1970) The state-trait anxiety inventory: test manual. Consulting Psychologist Press, Palo Alto
Sullivan M, Tanzer M, Stanish W, Fallaha M, Keefe FJ, Simmonds M, Dunbar M (2009) Psychological determinants of problematic outcomes following total knee arthroplasty. Pain 143(1–2):123–129
Tekur P, Nagarathna R, Chametcha S, Hankey A, Nagendra HR (2012) A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain patients more than exercise: an RCT. Complement Ther Med 20(3):107–118
Toms AD, Mandalia V, Haigh R, Hopwood B (2009) The management of patients with painful total knee replacement. J Bone Joint Surg Br 91(2):143–150
Valdes AM, Doherty SA, Zhang W, Muir KR, Maciewicz RA, Doherty M (2012) Inverse relationship between preoperative radiographic severity and postoperative pain in patients with osteoarthritis who have undergone total joint arthroplasty. Semin Arthritis Rheum 41(4):568–575
Vissers MM, Bussmann JB, Verhaar JA, Busschbach JJ, Bierma-Zeinstra SM, Reijman M (2012) Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review. Semin Arthritis Rheum 41(4):576–588
Wylde V, Hewlett S, Learmonth ID, Dieppe P (2011) Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain 152(3):566–572
Acknowledgments
We greatly thank the ENDO-Stiftung, Hamburg, Germany and the Swiss Society of Orthopaedic Surgery and Traumatology (Schweizerische Gesellschaft für Orthopädie und Traumatologie SGOT), Lucerne, Switzerland for financial support of the study. We are also grateful to Dr. phil. Daniela Heimberg for her help and advice in psychological scoring.
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Hirschmann, M.T., Testa, E., Amsler, F. et al. The unhappy total knee arthroplasty (TKA) patient: higher WOMAC and lower KSS in depressed patients prior and after TKA. Knee Surg Sports Traumatol Arthrosc 21, 2405–2411 (2013). https://doi.org/10.1007/s00167-013-2409-z
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DOI: https://doi.org/10.1007/s00167-013-2409-z