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

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 30 April 2014

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.

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Acknowledgments

We thank the staff members of the Orthopaedics Department of Guadalajara University Hospital and Alcala University (Madrid, Spain) for participating in this project.

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Correspondence to Alfonso Utrillas-Compaired MD, PhD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Guadalajara University Hospital, Guadalajara, Spain.

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Utrillas-Compaired, A., De la Torre-Escuredo, B.J., Tebar-Martínez, A.J. et al. Does Preoperative Psychologic Distress Influence Pain, Function, and Quality of Life After TKA?. Clin Orthop Relat Res 472, 2457–2465 (2014). https://doi.org/10.1007/s11999-014-3570-5

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  • DOI: https://doi.org/10.1007/s11999-014-3570-5

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