Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty
Open accessAbstract
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.
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Among people who seek care for chronic musculoskeletal pain, those with coexisting depression and/or anxiety report worse pain, greater physical impairment, increased postoperative opioid use, and a lower rate of return to work than those without depression and anxiety.
“For example, among people who seek care for chronic musculoskeletal pain, those with coexisting depression and/or anxiety report worse pain, greater physical impairment, increased postoperative opioid use, and a lower rate of return to work than those without depression and anxiety [8-11].”
From A Digital Mental Health Intervention in an Orthopedic Setting for Patients With Symptoms of Depression and/or Anxiety: Feasibility Prospective Cohort Study (2022) · cites this paper as [11]
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Prothèses totales de genou douloureuses
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- Authors
- Alattas, S. A., Smith, T., Bhatti, M., Wilson-Nunn, D., & Donell, S.
- Affiliations
- University of East Anglia (GB)
- University of Warwick (GB)
- Corresponding author
- Alattas, Sharifah Adla
- Smith, Toby
- Bhatti, Maria
- Wilson-Nunn, Daniel
- Donell, Simon
- Venue
- Knee Surgery, Sports Traumatology, Arthroscopy
- Publisher
- Wiley
- Published
- 2016-10-12
- Volume
- 25
- Issue
- 11
- Pages
- 3403-3410
- ISSN
- 0942-2056 (ISSN-L)
- 1433-7347
- PMC
- PMC5644683
- OpenAlex
- W2531661140
- Cited by
- 151
- References
- 32
- Citations by year
- 2026: 11 · 2025: 20 · 2024: 15 · 2023: 25 · 2022: 14 · 2021: 17 · 2020: 29 · 2019: 9 · 2018: 8 · 2017: 3
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Knee Surgery Sports Traumatology Arthroscopy (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion, cc-by)
- Funders
- University of East Anglia
- Topics
- Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Keywords
- total knee arthroplasty, preoperative anxiety, preoperative pain, knee function, health-related quality of life, patient satisfaction, predictors of surgical outcome, depression, psychological screening, preoperative assessment, comorbidities, body mass index
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anxiety, Depression, Female, Humans, Knee Joint, Male, Middle Aged, Quality of Life, Risk Factors, Cohort Studies, Treatment Outcome, Arthralgia, Arthroplasty, Replacement, Knee, Osteoarthritis, Knee
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