Cited by 151Total Knee Arthroplasty OutcomesMusculoskeletal pain and rehabilitationAnesthesia and Pain Management

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

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Alattas, Sharifah Adla, Smith, Toby, Bhatti, Maria, Wilson-Nunn, Daniel, Donell, Simon·2017·Knee Surgery, Sports Traumatology, Arthroscopy

DOI 10.1007/s00167-016-4314-8PMC PMC5644683

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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.

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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
ORCID: Smith, Toby
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
DOI: 10.1007/s00167-016-4314-8
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
Licence: cc-by
creativecommons.org/licenses/by/4.0 (unspecified)
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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › 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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Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty

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