Elsevier

The Journal of Arthroplasty

Volume 31, Issue 12, December 2016, Pages 2750-2756
The Journal of Arthroplasty

Primary Arthroplasty
Preoperative Predictors of Pain Catastrophizing, Anxiety, and Depression in Patients Undergoing Total Joint Arthroplasty

https://doi.org/10.1016/j.arth.2016.05.056Get rights and content

Abstract

Background

The relationship between pain catastrophizing and emotional disorders including anxiety and depression in osteoarthritic patients undergoing total joint arthroplasty (TJA) is an emerging area of study. The purpose of this study was to examine the association of these factors with preoperative patient characteristics.

Methods

A prospective cohort study of preoperative TJA patients using the Pain Catastrophizing Scale (PCS) and Hospital Anxiety and Depression Scale (HADS-A/HADS-D) was conducted. Preoperative measures included visual analog pain scale (VAS), Harris Hip and Knee Society scores, Oxford Score, and Kellgren–Lawrence grade. Logistic and quantile regression were used to assess the relationship between preoperative characteristics and PCS or HADS, adjusting for covariate effects.

Results

We recruited 463 TJA patients. VAS pain (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.04-1.45) and Oxford (OR 1.13; 95% CI 1.07-1.20) were significant predictors for PCS and its subdomains excluding rumination. Oxford was the only significant predictor for abnormal HADS-A (OR 1.10; 95% CI 1.04-1.17). VAS pain (OR 1.27; 95% CI 1.02-1.52) and Oxford (OR 1.09; 95% CI 1.01-1.17) were significant predictors for abnormal HADS-D. The quantile regression showed similar patterns of association, with female gender, younger age, and higher ASA also associated with HADS-A.

Conclusion

The most important predictor of catastrophizing, anxiety and/or depression in TJA patients is preoperative pain and poor subjective function. At-risk patients include those with increased pain and generally good clinical function, as well as younger women with significant comorbidities. Such patients should be identified and targeted psychological therapy implemented preoperatively to optimize coping strategies and adaptive behavior to mitigate potential for inferior TJA outcomes including pain and patient dissatisfaction.

Section snippets

Methods

A prospective cohort study of preoperative patients presenting for elective primary hip or knee arthroplasty was conducted to determine the association of pain CRC and hospital-related anxiety and depression with demographic and preoperative clinical profiles (hip and/or knee pain rating, function, and radiographic grading of OA).

All patients scheduled to undergo primary unilateral TJA for a diagnosis of OA performed among 7 orthopedic surgeons at 1 high-volume academic arthroplasty center over

Results

Of 1299 patients who underwent TJA (hip = 530, knee = 769) during the study period, a sample of 463 patients, including 178 primary unilateral hips (38.4%) and 285 primary unilateral knees (61.6%) met the inclusion criteria, consented to participate and completed the relevant outcome measures.

Table 1 summarizes the distribution characteristics of study participants. The proportion of females was slightly higher than that of males (56.8%, n = 263) with median age of 68 years (IQR 61-74 years).

Discussion

The relationship of CRC and emotional disorders including depression and anxiety in patients with osteoarthritic pain undergoing total hip or knee arthroplasty is an emerging area of study. Each individual experiences their preoperative arthritic joint uniquely with great variability in pain, anxiety, and psychological impact [2]. The purpose of this study was to evaluate the association between preoperative pain CRC, depression, and/or anxiety with preoperative TJA patient characteristics

Acknowledgments

The authors gratefully acknowledge Liz Piccirillo, RN, for her contributions toward project completion.

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.05.056.

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