CORR Insights^®: Does Preoperative Psychologic Distress Influence Pain, Function, and Quality of Life After TKA?

Excerpt

Although total joint arthroplasty of the knee and hip are recognized as highly successful procedures to relieve pain and improve function, a sizable group of patients fail to achieve an improvement after their surgery. An unfavorable result may arise following intra or postoperative complications, and may be more likely in patients with preoperative medical comorbidities or particular psychological risk factors. Regardless of the causes, we know that complications will happen, and as more procedures are performed — surgical volumes appear to be increasing [1] — there will be a greater number of both unhappy and pleased patients. A crucial feature of TKA is the arduous and painful postoperative therapy, which is critical to a patient achieving pain relief and restoration of function. Physical therapy may be more than some patients can tolerate, particularly patients with certain psychological comorbidities, such as uncontrolled depression and anxiety. Preoperatively identifying patients with psychological issues that place them at risk for chronic pain or clinical dissatisfaction after TKA remains a formidable challenge for the arthroplasty surgeon. This characterization would permit a referral of the patient to an appropriate counseling service, and a deferral of the surgery until the problem has been suitably addressed. …