Do Psychological Factors Predict Poor Outcome in Patients Undergoing TKA? A Systematic Review

Abstract

Background A subgroup of patients undergoing TKA is unhappy with the outcome of surgery and preoperative psychological factors may play a role in their dissatisfaction. Questions/purposes We asked whether (1) psychological factors, as measured by preoperative self-reported questionnaires, predicted poor outcome after TKA, and (2) whether certain psychological factors examined predicted poor outcome better than others. Methods We performed a systematic review and metaanalysis of prospective observational studies published in MEDLINE, CINAHL 1 , EMBASE TM , and PsycINFO 1 databases from their date of inception to October 2013, augmented with a manual search of bibliographies. Study eligibility was performed according to an a priori protocol. Included studies were assessed for quality according to the Newcastle-Ottawa scale. Two reviewers independently performed the search, identified eligible studies, assessed their methodologic quality, and extracted data. Outcomes of interest included postoperative dissatisfaction, pain, or limited function of the patients.

Patient Dissatisfaction after Total Knee Arthroplasty for Advanced Painful Osteoarthritis of the Knee

“…The rate of dissatisfied patients ranged between 8% and 19% (12% on average) in the osteoarthritis literature [2][3][4][5][6][7][8][9][10][11] . We found many causes of dissatisfaction reported in osteoarthritic patients that we must try to avoid, mainly a high preoperative body-mass index (> 27 kg/m²), lack of fulfillment of patient expectations (expectations not met -10.7 × greater risk), a low 1-year WOMAC (2.5 × greater risk), preoperative pain at rest (2.4 × greater risk), a postoperative complication requiring hospital readmission (1.9 × greater risk), preoperative mental factors (poor preoperative psychological state of a patient), and African American population [2][3][4][5][6][7][8][9][10][11] .…”

“…The narrative review the literature on APOAK found a rate of dissatisfaction ranging between 8% and 19% (12% on average) [2][3][4][5][6][7][8][9][10][11] . Causes of dissatisfaction in APOAK were mainly a high preoperative BMI, lack of fulfillment of patient expectations, a low 1-year WOMAC (Western Ontario and McMaster University Arthritis Index), preoperative pain at rest, a postoperative complication requiring hospital readmission, and a poor preoperative psychological state.…”

“…Three hundred and seventy-four articles were found in MedLine on osteoarthritis. Of those, only 10 were selected and reviewed because they were strictly focused on the topic of this article (this was the basis for rejection or acceptance of articles) [2][3][4][5][6][7][8][9][10][11] . The second search engine was the Cochrane Library, where only four randomized clinical trials (RCTs) were found on osteoarthritis [12][13][14][15] .…”

“…However, some patients with APOAK are not satisfied despite a good clinical result [1][2][3][4][5][6][7][8][9][10][11][12][13][14] . In this study APOAK was defined when the radiological study showed a grade 4 involvement in the Kellgren-Lawrence's scale (Table 1) [1] .…”

CORR ® International—Asia-Pacific: How To Live a Happy Life as an Orthopaedic Surgeon

“…The author certifies that he, or any member of his 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. thresholds, unrealistic preoperative expectations, and psychological disorders [1,4]. Recent studies [10,13] reveal that orthopaedic surgeons in China have experienced psychological and even physical threats by patients or family members, suggesting perhaps that it is more challenging to establish a healthy doctor-patient relationship in Asia than in other countries.…”