Patient Resilience Has Moderate Correlation With Functional Outcomes, but Not Satisfaction, After Primary Unilateral Total Knee Arthroplasty

Abstract

Background: As many as 20% of patients who undergo total knee arthroplasty (TKA) are dissatisfied. Psychological factors have been shown to play a role in outcomes after TKA. The purpose of this study was to investigate the impact of patient resilience on functional outcomes and satisfaction after primary unilateral TKA. Methods: Eighty-six patients who underwent primary unilateral TKA by a single surgeon were studied. Primary outcomes were the Brief Resilience Scale (BRS), mental health component of the Veterans Rand 12-Item Health Survey (VR-12 MCS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and New Knee Society Score. Correlations between BRS and dependent variables were found by using Spearmen's Rho Correlation testing. Unadjusted and adjusted regressions were run using the delta values as the dependent outcome and the BRS score as the main independent value, with data presented as an estimate of 95% confidence interval P value. Results: Resilience significantly correlated with male sex (P ¼ .031), preoperative VR-12 MCS scores (P ¼ .013), and postoperative VR-12 MCS scores (P < .001). BRS had moderate correlation with postoperative Knee Society Scores (KSS) Functional Activity Scores, as this approached, but did not achieve statistical significance (P ¼ .062). There was no correlation between BRS and postoperative KSS Patient Expectations score, KSS Patient Satisfaction score, or total postoperative opioid usage. Conclusions: Primary TKA patients with greater resilience are more likely to be male and have better mental health characteristics than those with lower resilience. Patients with greater resilience also tended to have improved knee function after TKA, although this was not statistically significant. Resiliency did not correlate with postoperative opioid consumption or patient satisfaction after TKA.

Association Between Preoperative Patient Resilience and Patient-Reported Outcomes After Rotator Cuff Repair

“… 3 , 10 , 16 A recent study evaluating total knee arthroplasty (TKA) patients showed that preoperative resilience is an important predictor of physical and mental health of patients at 3 months and 12 months postsurgery. 16 Further, greater concurrent resilience was associated with better scores across all measured outcomes, which is in contrast to a recent study of TKA patients by Haffar et al 8 which found no significant correlation between resilience and patient-reported outcome scores, both measured 1 year postoperatively. 16 In a similar study, Tokish et al 27 assessed 70 total shoulder arthroplasty (TSA) patients for a minimum of 2 years postoperatively and divided the patients into 3 groups based on Brief Resilience Scale (BRS) scores (low-resilience, normal-resilience, and high-resilience).…”

Low Preoperative Brief Resilience Scale Scores Are Associated With Inferior Preoperative and Short-Term Postoperative Patient Outcomes Following Primary Autograft Anterior Cruciate Ligament Reconstruction

“…There have been numerous studies linking an individual’s resilience to their mental well-being, 40 , 41 , 42 , 43 , 44 as well as their expectations following a procedure. 45 , 46 , 47 Most of the differences seen between the groups were during the preoperative period and up to 1 year postoperatively, with comparable results seen at final follow-up among all groups. A possible explanation to this may be that lower resiliencies in those undergoing ACLR may affect short-term PROMs more than long-term PROMs because they are experiencing a more difficult time coping with the procedure itself and during the rehabilitation process.…”

Patient Resilience Does Not Conclusively Affect Clinical Outcomes Associated With Arthroscopic Surgery but Substantial Limitations of the Literature Exist

“…Collectively, these studies have shown an association with higher resilience and superior physical function after surgery. 12 , 13 , 14 , 27 , 28 Among 152 patients with a hip fracture treated with surgery, Lim et al. 29 observed a positive correlation between preoperative resilience and higher physical function subscale scores on the Short Form-36 instrument.…”