Negative emotions affect postoperative scores for evaluating functional knee recovery and quality of life after total knee replacement

Abstract

This study aimed to determine whether psychological factors affect health-related quality of life (HRQL) and recovery of knee function in total knee replacement (TKR) patients. A total of 119 TKR patients (male: 38; female: 81) completed the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), State Trait Anxiety Inventory (STAI), Eysenck Personality Questionnaire-revised (EPQR-S), Knee Society Score (KSS), and HRQL (SF-36). At 1 and 6 months after surgery, anxiety, depression, and KSS scores in TKR patients were significantly better compared with those preoperatively (P<0.05). SF-36 scores at the sixth month after surgery were significantly improved compared with preoperative scores (P<0.001). Preoperative Physical Component Summary Scale (PCS) and Mental Component Summary Scale (MCS) scores were negatively associated with extraversion (E score) (B=-0.986 and -0.967, respectively, both P<0.05). Postoperative PCS and State Anxiety Inventory (SAI) scores were negatively associated with neuroticism (N score; B=-0.137 and -0.991, respectively, both P<0.05). Postoperative MCS, SAI, Trait Anxiety Inventory (TAI), and BAI scores were also negatively associated with the N score (B=-0.367, -0.107, -0.281, and -0.851, respectively, all P<0.05). The KSS function score at the sixth month after surgery was negatively associated with TAI and N scores (B=-0.315 and -0.532, respectively, both P<0.05), but positively associated with the E score (B=0.215, P<0.05). The postoperative KSS joint score was positively associated with postoperative PCS (B=0.356, P<0.05). In conclusion, for TKR patients, the scores used for evaluating recovery of knee function and HRQL after 6 months are inversely associated with the presence of negative emotions.

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

“…The evidence presented with a number of strengths (Supplementary Table 2); for example, each included study had a focused objective. Three papers [ 4 , 20 , 23 ] failed to identify a gap in the existing literature. All outcome measures were validated.…”

“…Hirschmann et al [ 10 ] found that higher levels of pre-operative trait anxiety predicted greater pain (Spearman’s rho = 0.25; p < 0.05) and stiffness (Spearman’s rho = 0.26; p < 0.05). Qi et al [ 23 ] demonstrated that pre-operative anxiety as measured by the Trait Anxiety Inventory (TAI) predicted poorer knee function at 6 months.…”

“…This affected the interpretation of five predictors. Despite the exclusion of two papers [ 23 , 30 ], anxiety remained a strong predictor of worse HRQoL score and depression remained as a significant predictor of outcome. This analysis slightly affected the degree of certainty that pre-operative pain and function reduce the HRQoL.…”

Screening preoperative anxiety – when does it relate to the quality of life among patients before total joint replacement? Preliminary reports

“…Both THA and TKA are often reported to improve physical functioning and HRQoL (Czyzewska, Glinkowski, & Walesiak, 2014;Elmallah et al, 2016;Rat et al, 2010). At the same time, anxiety preceding TJA affects the postoperative functional status, satisfaction with joint replacement, general quality of health index, and increases the risk of complications, and pain, along with the experience of pain up to two years after surgery (Khatib, Jenkin, Naylor, & Harris, 2016;Khatib, Madan, Naylor, & Harris, 2015;Gill & Mc-Burney, 2013;Qi et al, 2016;Rasouli, Menendez, Sayadipour, Purtill, & Parvizi, 2016;Singh & Lewallen, 2013;Vissers et al, 2012). Ayers with coworkers (2004) observed that the preoperative mental component of the HRQoL measurement predicted the score of the physical component of the same tool six months after surgery, indicating the need for longterm emotional support to enhance patient recovery.…”

Does standard post-operative rehabilitation have its place after total knee replacement?

“…Its prevalence associates with aging and gender. According to the World Health Organization, OA is commonly regarded as the most important cause of function disability (1)(2)(3)(4). Current treatment of OA aims to improve pain and function and enhance quality of life (5).…”