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Knee Surg Sports Traumatol Arthrosc. 2017 Nov;25(11):3403-3410. doi: 10.1007/s00167-016-4314-8. Epub 2016 Oct 12.

Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty.

Author information

1
Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK. Sharifah.Alattas@uea.ac.uk.
2
Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
3
Department of Statistics, University of Warwick, Coventry, UK.
4
Department of Orthopaedic Surgery, Norfolk and Norwich University Hospital, University of East Anglia, Norwich, UK.

Abstract

PURPOSE:

Around 10-30 % of patients are dissatisfied with the results of their total knee arthroplasty (TKA). This review aimed to identify and evaluate the predictors of outcome measured by the three domains of health-related quality of life (pain, stiffness and function). The focus was on pre-operative psychological factors as related to other patient-related variables.

METHODS:

A systematic search was performed using the following databases: MEDLINE, PubMed, AMED, CINAHL, PsychINFO, SciFinder, Scopus, EMBASE, Cochrane, Lilacs, Web of Science and ScienceDirect. The quality of identified studies was assessed using the Critical Appraisal Skills Programme Cohort checklist.

RESULTS:

Ten studies met the eligibility criteria. From these, nine patient-related predictors of outcome were identified (depression, anxiety, age at surgery, gender (being female), medical co-morbidities, BMI, level of education, pre-operative pain severity and pre-operative knee function). Greater anxiety, pre-operative pain and function were the most significant factors to predict a poorer outcome of a TKA. The results of depression, gender (female), medical co-morbidities, BMI and level of education were variable among the included studies. There was very little evidence to support older age at operation as a predictor of poorer outcome.

CONCLUSION:

Patients experiencing high levels of pain before surgery should be informed of the chances of improvement by having a TKA. A validated psychological screening tool that separates depression and anxiety is recommended as part of the pre-operative assessment stage. Patients presenting with symptoms of depression and anxiety should be identified and consulted before a TKA.

LEVEL OF EVIDENCE:

II.

KEYWORDS:

Anxiety; Depression; Outcome; Quality of life; Results; Total knee arthroplasty

PMID:
27734110
PMCID:
PMC5644683
DOI:
10.1007/s00167-016-4314-8
[Indexed for MEDLINE]
Free PMC Article

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