Skip to main content
SpringerLink
Log in

Preoperative Pain Catastrophizing Predicts Pain Outcome after Knee Arthroplasty

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

Abstract

Psychologic status is associated with poor outcome after knee arthroplasty yet little is known about which specific psychologic disorders or pain-related beliefs contribute to poor outcome. To enhance the therapeutic effect of a psychologic intervention, the specific disorders or pain-related beliefs that contributed to poor outcome should be identified. We therefore determined whether specific psychologic disorders (ie, depression, generalized anxiety disorder, panic disorder) or health-related beliefs (ie, self-efficacy, pain catastrophizing, fear of movement) are associated with poor outcome after knee arthroplasty. We conducted a cohort study of 140 patients undergoing knee arthroplasty at two hospitals. Patients completed a series of psychologic measures, provided various sociodemographic data, and were followed for 6 months. Patients were dichotomized to groups with either a favorable or a poor outcome using WOMAC pain and function scores and evidence-based approaches. After adjusting for confounding variables, we found pain catastrophizing was the only consistent psychologic predictor of poor WOMAC pain outcome. No psychologic predictors were associated consistently with poor WOMAC function outcome. An intervention focusing on pain catastrophizing seems to have potential for improving pain outcome in patients prone to catastrophizing pain.

Level of Evidence: Level I, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. 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.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. Bachmeier CJ, March LM, Cross MJ, Lapsley HM, Tribe KL, Courtenay BG, Brooks PM; Arthritis Cost and Outcome Project Group. A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery. Osteoarthritis Cartilage. 2001;9:137–146.

    Article  CAS  PubMed  Google Scholar 

  4. 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  Google Scholar 

  5. Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, Houle T. Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res. 2003;416:27–36.

    Article  PubMed  Google Scholar 

  6. Chibnall JT, Tait RC. Confirmatory factor analysis of the Pain Catastrophizing Scale in African American and Caucasian Workers’ Compensation claimants with low back injuries. Pain. 2005;113:369–375.

    Article  PubMed  Google Scholar 

  7. Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Majkowski GR, Delitto A. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med. 2004;141:920–928.

    PubMed  Google Scholar 

  8. Dixon KE, Keefe FJ, Scipio CD, Perri LM, Abernethy AP. Psychological interventions for arthritis pain management in adults: a meta-analysis. Health Psychol. 2007;26:241–250.

    Article  PubMed  Google Scholar 

  9. Edwards RR, Bingham CO 3rd, Bathon J, Haythornthwaite JA. Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis Rheum. 2006;55:325–332.

    Article  PubMed  Google Scholar 

  10. Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I. Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage. 2007;15:273–280.

    Article  CAS  PubMed  Google Scholar 

  11. Escobar A, Quintana JM, Bilbao A, Azkarate J, Guenaga JI, Arenaza JC, Gutierrez LF. Effect of patient characteristics on reported outcomes after total knee replacement. Rheumatology (Oxford). 2007;46:112–119.

    Article  CAS  Google Scholar 

  12. Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty: a qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004;86:963–974.

    PubMed  Google Scholar 

  13. Fitzgerald JD, Orav EJ, Lee TH, Marcantonio ER, Poss R, Goldman L, Mangione CM. Patient quality of life during the 12 months following joint replacement surgery. Arthritis Rheum. 2004;51:100–109.

    Article  PubMed  Google Scholar 

  14. Forsythe ME, Dunbar MJ, Hennigar AW, Sullivan MJ, Gross M. Prospective relation between catastrophizing and residual pain following knee arthroplasty: two-year follow-up. Pain Res Manag. 2008;13:335–341.

    PubMed  Google Scholar 

  15. Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, Phillips C, Partridge AJ, Bélisle 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.

    Article  CAS  PubMed  Google Scholar 

  16. Fortin PR, Penrod JR, Clarke AE, St-Pierre Y, Joseph L, Belisle P, Liang MH, Ferland D, Phillips CB, Mahomed N, Tanzer M, Sledge C, Fossel AH, Katz JN. Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum. 2002;46:3327–3330.

    Article  PubMed  Google Scholar 

  17. Hamel MB, Toth M, Legedza A, Rosen MP. Joint replacement surgery in elderly patients with severe osteoarthritis of the hip or knee: decision making, postoperative recovery, and clinical outcomes. Arch Intern Med. 2008;168:1430–1440.

    Article  PubMed  Google Scholar 

  18. Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, Katz B, Bombadier C, Heck D, Freund D. Health-related quality of life after knee replacement. J Bone Joint Surg Am. 1998;80:163–173.

    CAS  PubMed  Google Scholar 

  19. Heck DA, Robinson RL, Partridge CM, Lubitz RM, Freund DA. Patient outcomes after knee replacement. Clin Orthop Relat Res. 1998;356:93–110.

    Article  PubMed  Google Scholar 

  20. Heuts PH, Vlaeyen JW, Roelofs J, de Bie RA, Aretz K, van Weel C, van Schaylck OC. Pain-related fear and daily functioning in patients with osteoarthritis. Pain. 2004;110:228–235.

    Article  PubMed  Google Scholar 

  21. Hill JC, Lewis M, Sim J, Hay EM, Dziedzic K. Predictors of poor outcome in patients with neck pain treated by physical therapy. Clin J Pain. 2007;23:683–690.

    Article  PubMed  Google Scholar 

  22. Jellema P, van der Horst HE, Vlaeyen JW, Stalman WA, Bouter LM, van der Windt DA. Predictors of outcome in patients with (sub)acute low back pain differ across treatment groups. Spine. 2006;31:1699–1705.

    Article  PubMed  Google Scholar 

  23. Jellema P, van der Windt DA, van der Horst HE, Stalman WA, Bouter LM. Prediction of an unfavourable course of low back pain in general practice: comparison of four instruments. Br J Gen Pract. 2007;57:15–22.

    PubMed  Google Scholar 

  24. Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME. Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. J Rheumatol. 2000;27:1745–1752.

    CAS  PubMed  Google Scholar 

  25. Keefe FJ, Abernethy AP, Campbell LC. Psychological approaches to understanding and treating disease-related pain. Annu Rev Psychol. 2005;56:601–630.

    Article  PubMed  Google Scholar 

  26. Keefe FJ, Caldwell D, Williams DA, Gil KM, Mitchell D, Robertson C, Martinez S, Nunley J, Beckham JC, Crisson JE, Helms M. Pain coping skills training in the management of osteoarthritic knee pain: a comparative study. Behavior Therapy. 1990;21:49–62.

    Article  Google Scholar 

  27. Keefe FJ, Rumble ME, Scipio CD, Giordano LA, Perri LM. Psychological aspects of persistent pain: current state of the science. J Pain. 2004;5:195–211.

    Article  PubMed  Google Scholar 

  28. Keefe FJ, Smith SJ, Buffington AL, Gibson J, Studts JL, Caldwell DS. Recent advances and future directions in the biopsychosocial assessment and treatment of arthritis. J Consult Clin Psychol. 2002;70:640–655.

    Article  PubMed  Google Scholar 

  29. Kennedy DM, Stratford PW, Riddle DL, Hanna SE, Gollish JD. Assessing recovery and establishing prognosis following total knee arthroplasty. Phys Ther. 2008;88:22–32.

    PubMed  Google Scholar 

  30. Kosinski M, Keller SD, Ware JE Jr, Hatoum HT, Kong SX. The SF-36 Health Survey as a generic outcome measure in clinical trials of patients with osteoarthritis and rheumatoid arthritis: relative validity of scales in relation to clinical measures of arthritis severity. Med Care. 1999;37:MS23–MS39.

    Article  CAS  PubMed  Google Scholar 

  31. Kroenke K, Spitzer RL. The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals. 2002;32:1–7.

    Google Scholar 

  32. Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114:163–173.

    Article  PubMed  Google Scholar 

  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  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  35. Lingard EA, Sledge CB, Learmonth ID, Kinemax Outcomes Group. Patient expectations regarding total knee arthroplasty: differences among the United States, United kingdom, and Australia. J Bone Joint Surg Am. 2006;88:1201–1207.

    Article  PubMed  Google Scholar 

  36. Lorig K, Gonzalez VM, Laurent DD, Morgan L, Laris BA. Arthritis self-management program variations: three studies. Arthritis Care Res. 1998;11:448–454.

    Article  CAS  PubMed  Google Scholar 

  37. Lorig K, Ritter PL, Plant K. A disease-specific self-help program compared with a generalized chronic disease self-help program for arthritis patients. Arthritis Rheum. 2005;53:950–957.

    Article  PubMed  Google Scholar 

  38. Lorig KR, Ritter PL, Laurent DD, Plant K. The internet-based arthritis self-management program: a one-year randomized trial for patients with arthritis or fibromyalgia. Arthritis Rheum. 2008;59:1009–1017.

    Article  PubMed  Google Scholar 

  39. McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum. 2001;45:453–461.

    Article  CAS  PubMed  Google Scholar 

  40. Mueller A, Hartmann M, Mueller K, Eich W. Validation of the arthritis self-efficacy short-form scale in German fibromyalgia patients. Eur J Pain. 2003;7:163–171.

    Article  PubMed  Google Scholar 

  41. Murray DW, Frost SJ. Pain in the assessment of total knee replacement. J Bone Joint Surg Br. 1998;80:426–431.

    Article  CAS  PubMed  Google Scholar 

  42. NIH Consensus Panel. NIH Consensus Statement on total knee replacement December 8–10, 2003. J Bone Joint Surg Am. 2004;86:1328–1335.

    Google Scholar 

  43. Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006;452:35–43.

    Article  PubMed  Google Scholar 

  44. Osman A, Barrios FX, Gutierrez PM, Kopper BA, Merrifield T, Grittmann L. The Pain Catastrophizing Scale: further psychometric evaluation with adult samples. J Behav Med. 2000;23:351–365.

    Article  CAS  PubMed  Google Scholar 

  45. Rasanen P, Paavolainen P, Sintonen H, Koivisto AM, Blom M, Ryynanen OP, Roine RP. Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthop. 2007;78:108–115.

    Article  PubMed  Google Scholar 

  46. 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.

    Article  PubMed  Google Scholar 

  47. Sharma L, Sinacore J, Daugherty C, Kuesis DT, Stulberg SD, Lewis M, Baumann G, Chang RW. Prognostic factors for functional outcome of total knee replacement: a prospective study. J Gerontol A Biol Sci Med Sci. 1996;51:M152–M157.

    CAS  PubMed  Google Scholar 

  48. Spitzer RL, Kroenke K, Linzer M, Hahn SR, Williams JB, deGruy FV 3rd, Brody D, Davies M. Health-related quality of life in primary care patients with mental disorders: results from the PRIME-MD 1000 Study. JAMA. 1995;274:1511–1517.

    Article  CAS  PubMed  Google Scholar 

  49. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282:1737–1744.

    Article  CAS  PubMed  Google Scholar 

  50. Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–1097.

    Article  PubMed  Google Scholar 

  51. Spitzer RL, Williams JB, Kroenke K, Hornyak R, McMurray J. Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. Am J Obstet Gynecol. 2000;183:759–769.

    Article  CAS  PubMed  Google Scholar 

  52. Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychological Assessment. 1995;7:524–532.

    Article  Google Scholar 

  53. Tubach F, Ravaud P, Baron G, Falissard B, Logeart I, Bellamy N, Bombadier C, Felson D, Hochberg M, van der Heijde D, Dougados M. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis. 2005;64:29–33.

    Article  CAS  PubMed  Google Scholar 

  54. van den Akker-Scheek I, Stevens M, Groothoff JW, Bulstra SK, Zijlstra W. Preoperative or postoperative self-efficacy: which is a better predictor of outcome after total hip or knee arthroplasty? Patient Educ Couns. 2007;66:92–99.

    Article  PubMed  Google Scholar 

  55. Woby SR, Roach NK, Urmston M, Watson PJ. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain. 2005;117:137–144.

    Article  PubMed  Google Scholar 

  56. Wright RJ, Sledge CB, Poss R, Ewald FC, Walsh ME, Lingard EA. Patient-reported outcome and survivorship after Kinemax total knee arthroplasty. J Bone Joint Surg Am. 2004;86:2464–2470.

    PubMed  Google Scholar 

  57. Wylde V, Dieppe P, Hewlett S, Learmonth ID. Total knee replacement: is it really an effective procedure for all? Knee. 2007;14:417–423.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the patients who consented to participate and the orthopaedic surgeons who conducted the surgeries.

Author information

Authors and Affiliations

  1. Departments of Physical Therapy and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, 23298-0224, USA

    Daniel L. Riddle PT, PhD, FAPTA

  2. Department of Psychiatry, Neurology, and Anaesthesiology, Virginia Commonwealth University, Richmond, VA, USA

    James B. Wade PhD

  3. Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA

    William A. Jiranek MD

  4. Department of Family Population and Reproductive Health, The Johns Hopkins University, Baltimore, MD, USA

    Xiangrong Kong PhD

Authors
  1. Daniel L. Riddle PT, PhD, FAPTA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James B. Wade PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William A. Jiranek MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiangrong Kong PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel L. Riddle PT, PhD, FAPTA.

Additional information

One or more of the authors (DLR, JBW, WAJ) have received funding from a grant from the AD Williams Fund, Virginia Commonwealth University, Richmond, VA.

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 Virginia Commonwealth University, Richmond, VA, USA.

About this article

Cite this article

Riddle, D.L., Wade, J.B., Jiranek, W.A. et al. Preoperative Pain Catastrophizing Predicts Pain Outcome after Knee Arthroplasty. Clin Orthop Relat Res 468, 798–806 (2010). https://doi.org/10.1007/s11999-009-0963-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-009-0963-y

Keywords

Search

Navigation