Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 8/2014

01-08-2014 | Clinical Research

Does Preoperative Psychologic Distress Influence Pain, Function, and Quality of Life After TKA?

Authors: Alfonso Utrillas-Compaired, MD, PhD, Basilio J. De la Torre-Escuredo, MD, PhD, Ana J. Tebar-Martínez, MD, MPH, Ángel Asúnsolo-Del Barco, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 8/2014

Login to get access

Abstract

Background

Preoperative psychologic distress is considered to be a risk factor for clinical dissatisfaction stemming from persistent pain and physical limitations after elective orthopaedic procedures such as lower-extremity arthroplasty. However, the degree to which psychologic distress, specifically in the form of anxiety and depression, influences surgical results has been poorly characterized.

Questions/purposes

We analyzed the effect of preoperative psychologic distress on changes in pain, function, and quality of life 1 year after elective TKA.

Methods

In this prospective cohort study, we assessed patients who underwent TKAs in 2009 and 2010. Before surgery, patients completed the Folstein Mini Mental Test, the Hospital Anxiety and Depression Scale (HAD), The Knee Society Score©, the WOMAC quality-of-life questionnaire, and the VAS for pain. The patients were divided into two groups based on the degree of psychologic distress on the HAD Scale, and the groups were compared in terms of the above-listed clinical outcomes tools 1 year after surgery using multivariate linear models. Two hundred sixty-three patients met the inclusion criteria, and 202 (77%) completed the study protocol.

Results

The presence of preoperative psychologic distress did not influence 1-year postoperative pain assessment (average reduction in pain, 40.33; 95% CI, 36.9–43.8; p = 0.18). The only factor influencing change in pain experienced by patients was the preoperative pain recorded (R2 = 0.31; β = −0.82; p < 0.001). The patients experiencing preoperative psychologic distress obtained poorer outcomes in function (R2 = 0.16; β = −5.62; p = 0.001) and quality of life (R2 = 0.09; β = −0.46; p < 0.001) 1 year after receiving TKA.

Conclusions

The presence of preoperative psychologic distress is associated with worse 1-year outcomes for function and quality of life in patients undergoing TKA. Interventions designed to reduce psychologic distress may be indicated for patients to undergo this type of surgery, and incorporation of these data into discussions with patients may facilitate informed and shared decision making regarding the surgical treatment of knee osteoarthritis.

Level of Evidence

Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
Literature
1.
Ackerman IN, Graves SE, Wicks IP, Bennell KL, Osborne RH. Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery. Arthritis Rheum. 2005;53:653–658.PubMedCrossRef
2.
Ayers DC, Franklin PD, Ploutz-Snyder R, Boisvert CB. Total knee replacement outcome and coexisting physical and emotional illness. Clin Orthop Relat Res. 2005;440:157–161.PubMedCrossRef
3.
Ayers DC, Franklin PD, Trief PM, Ploutz-Snyder R, Freund D. Psychological attributes of preoperative total joint replacement patients: implications for optimal physical outcome. J Arthroplasty. 2004;19(7 suppl 2):125–130.PubMedCrossRef
4.
Bellamy N. WOMAC Osteoarthritis Index: A User’s Guide. London, Canada: Victoria Hospital; 1995.
5.
Bellamy N. The WOMAC Knee and Hip Osteoarthritis Indices: development, validation, globalization and influence on the development of the AUSCAN Hand Osteoarthritis Indices. Clin Exp Rheumatol. 2005;23(5 suppl 39):S148–153.PubMed
6.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. 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. 1988;15:1833–1840.PubMed
7.
BenDebba M, Torgerson WS, Long DM. Personality traits, pain duration and severity, functional impairment and psychological distress in patients with persistent low back pain. Pain. 1997;72:115–125.PubMedCrossRef
8.
Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res. 2002;52:69–77.PubMedCrossRef
9.
Brander V, Gondek S, Martin E, Stulberg SD. Pain and depression influence outcome 5 years after knee replacement surgery. Clin Orthop Relat Res. 2007;464:21–26.PubMed
10.
Brokelman RB, Van Loon CJ, Rijnberg WJ. Patient versus surgeon satisfaction after total hip arthroplasty. J Bone Joint Surg Br. 2003;85:495–498.PubMed
11.
Callahan CM, Drake BG, Heck DA, Dittus RS. Patient outcomes following tricompartmental total knee replacement: a meta-analysis. JAMA. 1994;271:1349–1357.PubMedCrossRef
12.
Caracciolo B, Giaquinto S. Self-perceived distress and self-perceived functional recovery after recent total hip and knee arthroplasty. Arch Gerontol Geriatr. 2005;41:177–181.PubMedCrossRef
13.
Damush TM, Weinberger M, Perkins SM, Rao JK, Tierney WM, Qi R, Clark DO. Randomized trial of a self-management program for primary care patients with acute low back pain: short-term effects. Arthritis Rheum. 2003;49:179–186.PubMedCrossRef
14.
Davis ET, Lingard EA, Schemitsch EH, Waddell JP. Effects of socioeconomic status on patients’ outcome after total knee arthroplasty. Int J Qual Health Care. 2008; 20:40–46.PubMedCrossRef
15.
Elson D, Brenkel I. Predicting pain after total knee arthroplasty. J Arthroplasty. 2006;21:1047–1053.PubMedCrossRef
16.
Folstein MF, Folstein SE, McHugh PR. Minimental state: a practical guide for cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198.PubMedCrossRef
17.
Forsythe ME, Dunbar MJ, Hennigar AW, Sullivan MJ, Gross M. Prospective relation between catastrophic and residual pain following knee arthroplasty: two-year follow-up. Pain Res Manag. 2008;13:335–341.PubMedCentralPubMed
18.
Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, Phillips C, Partridge AJ, Belisle P, Fossel AH, Mahomed N, Sledge CB, Katz JN. Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum.1999;42:1722–1728.PubMedCrossRef
19.
Franklin PD, Li W, Ayers DC. The Chitranjan Ranawat Award: functional outcome after total knee replacement varies with patient attributes. Clin Orthop Relat Res.2008;466:2597–2604.PubMedCentralPubMedCrossRef
20.
Gandhi R, Dhotar H, Razak F, Tso P, Davey JR, Mahomed NN. Predicting the longer term outcomes of total knee arthroplasty. Knee. 2010;17:15–18.PubMedCrossRef
21.
Härter M, Reuter K, Gross-Hardt K, Bengel J. Screening for anxiety, depressive and somatoform disorders in rehabilitation: validity of HADS and GHQ - 12 in patients with musculoskeletal disease. Disabil Rehabil. 2001;23:737–744.PubMedCrossRef
22.
Heck DA, Robinson RL, Partridge CM, Lubitz RM, Freund DA. Patient outcomes after knee replacement. Clin Orthop Relat Res. 1998;356:93–110.PubMedCrossRef
23.
Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44:227–239.PubMedCrossRef
24.
Herrero MJ, Blanch J, Peri JM, De-Pablo J, Pintora L, Bulbena A. A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population. General Hospital Psychiatry. 2003;25:277–283.PubMedCrossRef
25.
Herrmann C. International experiences with the Hospital Anxiety and Depression Scale: a review of validation data and clinical results. J Psychosom Res. 1997;42:17–41.PubMedCrossRef
26.
Holtzman J, Saleh K, Kane R. Effect of baseline functional status and pain on outcomes of total hip arthroplasty. J Bone Joint Surg Am. 2002;84:1942–1948.PubMed
27.
Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.PubMed
28.
Iorio R, Robb WJ, Healy WL, Berry DJ, Hozack WJ, Kyle RF, Lewallen DG, Trousdale RT, Jiranek WA, Stamos VP, Parsley BS. Orthopaedic surgeon workforce and volume assessment for total hip and knee replacement in the United States: preparing for an epidemic. J Bone Joint Surg Am. 2008;90:1598–1605.PubMedCrossRef
29.
Jones CA, Voaklander DC, Johnston DW, Suarez-Almanzor ME. Health related quality of life outcomes after total hip and knee artrhoplasties in a community based population. J Rheumatol. 2000;27:1745–1752.PubMed
30.
Jones CA, Voaklander DC, Suarez-Alma ME. Determinants of function after total knee arthroplasty. Phys Ther. 2003;83:696–706.PubMed
31.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.PubMedCrossRef
32.
33.
Lingard EA, Katz JN, Wright EA, Sledge CB; Kinemax Outcomes Group. Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am. 2004;86:2179–2186.PubMed
34.
Lingard EA, Riddle DL. Impact of psychological distress on pain and function following knee arthroplasty. J Bone Joint Surg Am. 2007;89:1161–1169.PubMedCrossRef
35.
Moore JE, Von Korff M, Cherkin D, Saunders K, Lorig K. A randomized trial of a cognitive-behavioral program for enhancing back pain self care in a primary care setting. Pain. 2000;88:145–153.PubMedCrossRef
36.
Nilsdotter AK, Toksvig-Larsen S, Roos EM. A 5 year prospective study of patient-relevant outcomes after total knee replacement. Osteoarthritis Cartilage. 2009;17:601–606.PubMedCrossRef
37.
Paulsen MG, Dowsey MM, Castle D, Choong PF. Preoperative psychological distress and functional outcome after knee replacement. ANZ J Surg. 2011;81:681–687.PubMedCrossRef
38.
Riddle DL, Wade JB, Jiranek WA, Kong X. Preoperative pain catastrophizing predicts pain outcome after knee arthroplasty. Clin Orthop Relat Res. 2010;468:798–806.PubMedCentralPubMedCrossRef
39.
40.
Salmon P, Hall GM, Peerbhoy D. Influence of the emotional response to surgery on functional recovery during 6 months after hip arthroplasty. J Behav Med. 2001;24:489–502.PubMedCrossRef
41.
Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum. 2003;49:156–163.PubMedCrossRef
42.
Santić V, Legović D, Sestan B, Jurdana H, Marinović M. Measuring improvement following total hip and knee arthroplasty using the SF-36 Health Survey. Coll Antropol. 2012;36:207–212.PubMed
43.
Singh JA, Gabriel S, Lewallen D. The impact of gender, age, and preoperative pain severity on pain after TKA. Clin Orthop Relat Res. 2008;466:2717–2723.PubMedCentralPubMedCrossRef
44.
Walton MJ, Newman JH. Preoperative mental wellbeing and the outcome of knee replacement. Knee. 2008;15:277–280.PubMedCrossRef
45.
Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990;13:227–236.PubMedCrossRef
46.
WHO. Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series 854. Geneva, Switzerland: World Health Organization; 1995.
47.
Wylde V, Dieppe P, Hewlett S, Learmonth ID. Total knee replacement: is it really an effective procedure for all? Knee. 2007;14:417–423.PubMedCrossRef
48.
Wylde V, Hewlett S, Learmonth D, Dieppe P. Persistent pain after joint replacement: Prevalence, sensory qualities, and postoperative determinants. Pain. 2011;152:566–572.PubMedCrossRef
49.
Zigmong AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370.CrossRef
50.
Zywiel MG, Stroh DA, Lee SY, Bonutti PM, Mont MA. Chronic opioid use prior to total knee arthroplasty. J Bone Joint Surg Am. 2011;93:1988–1993.PubMedCrossRef
Metadata
Title
Does Preoperative Psychologic Distress Influence Pain, Function, and Quality of Life After TKA?
Authors
Alfonso Utrillas-Compaired, MD, PhD
Basilio J. De la Torre-Escuredo, MD, PhD
Ana J. Tebar-Martínez, MD, MPH
Ángel Asúnsolo-Del Barco, MD, PhD
Publication date
01-08-2014
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 8/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-014-3570-5

Other articles of this Issue 8/2014

Clinical Orthopaedics and Related Research® 8/2014 Go to the issue

Letter to the Editor

Letter to the Editor: Is Stability of the Proximal Tibiofibular Joint Important in the Multiligament-injured Knee?

Basic Research

Carpal Tunnel Syndrome Impairs Thumb Opposition and Circumduction Motion

Symposium: Complex Issues in Glenohumeral Instability

Remplissage Versus Latarjet for Engaging Hill-Sachs Defects Without Substantial Glenoid Bone Loss: A Biomechanical Comparison

Symposium: Surgery and Science of the Rotator Cuff

Surgery and Science of the Rotator Cuff: Editorial Comment

In Brief

Classifications in Brief: Young and Burgess Classification of Pelvic Ring Injuries

Symposium: Surgery and Science of the Rotator Cuff

The Detrimental Effects of Systemic Ibuprofen Delivery on Tendon Healing Are Time-Dependent