Multiple joint involvement in total knee replacement for osteoarthritis: Effects on patient‐reported outcomes

Abstract

Objective. To determine whether symptomatic (painful/problematic) joints pre-total knee replacement (TKR) surgery influence 1) pre-and 12-month post-TKR patient-reported outcomes (pain, physical function, and mood [fatigue, anxiety, and depression]) and 2) postsurgical pain and function mediated through mood. Methods. A total of 494 participants completed the patient-reported outcome measures pre-and 12-months post-TKR. Symptomatic (painful/problematic) joints affected by arthritis were indicated on a homunculus presurgery. Covariate data included age, sex, educational attainment, body mass index, and comorbidity. Pre-and postsurgical outcome scores were regressed on symptomatic joint sites and covariates using linear regression analyses; postsurgical scores additionally were regressed on presurgery scores. Path analyses examined whether the effects of symptomatic joint sites on postsurgical pain and function were mediated through mood. Results. The age range was 35-88 years (mean 65 years) and 65% were women. Forty-six percent reported >4 symptomatic joints (other than the surgical knee). Pre-and postsurgery, worse outcome scores were observed with increasing joint count. Adjusted for covariates, individuals reporting symptomatic ankles/feet/toes, neck, and spine/lower back had worse presurgery fatigue and anxiety. Adjusted for covariates and presurgery status, worse fatigue for the neck and spine/lower back and worse depression, pain, and function for the ankles/feet/toes and neck were observed postsurgery. The influence of symptomatic ankles/feet/toes on postsurgical pain and function was in part direct and partially mediated through depression. Full mediation was found for the neck through fatigue, anxiety, and depression, and for the spine/lower back through fatigue. Conclusion. Findings suggest that a comprehensive approach to osteoarthritis management/care is warranted, and identify important associations between symptomatic joints and mood that negatively impact post-TKR pain and physical function.

What Is the Relationship Between Depressive Symptoms and Pain During Functional Tasks in Persons Undergoing TKA? A 6-year Perioperative Cohort Study

“…However, other studies have suggested depressive symptoms have little influence on pain or function postoperatively [21,25]. Our study was hypothesis-driven because several studies have reported inconsistent findings related to the prognostic value of preoperative depressive symptoms and the extent to which depressive symptoms change from the pre-to the postoperative period [5,6,12,16,17]. We found that preoperative depressive symptoms were not prognostic of the extent of postoperative pain and that the extent of depressive symptoms was essentially unchanged after surgery.…”

“…Our study had limitations, and our findings cannot be directly compared with other studies [5,6,17,27] for a variety of reasons. Our data were collected from OAI, a natural history knee OA study unlike other studies examining the prognostic importance of postoperative Fig.…”

“…Furthermore, our estimated effects were small and even if they were found to be statistically significant, it is unlikely they would be clinically relevant. Some prior studies have reported the timeframe for collecting patient preoperative depressive symptoms data, and, on average the studies collected data 12 days from surgery [17] and within a month of surgery [12]. Our study is limited in this regard because of the OAI time-varying design.…”

“…First, elevated preoperative depressive symptoms have been shown to be prognostic of worse patient postoperative pain and poorer function [5,6,12,17]. High levels of depressive symptoms likely make a challenging postoperative recovery even more difficult for patients and there is a moderate association between depression and pain [1,7].…”

Defining an International Standard Set of Outcome Measures for Patients With Hip or Knee Osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group

“…A similar physician‐reported measure of joint‐specific previous surgical history was also included in the set. Physicians are asked to report these measures for all 4 joints, as multiple joint involvement affects outcomes 42.…”