Preoperative Anxiety and Depression Correlate With Dissatisfaction After Total Knee Arthroplasty: A Prospective Longitudinal Cohort Study of 186 Patients, With 4-Year Follow-Up

doi:10.1016/j.arth.2016.08.033

The Journal of Arthroplasty

Volume 32, Issue 3, March 2017, Pages 767-770

https://doi.org/10.1016/j.arth.2016.08.033 Get rights and content

Abstract

Background

After more than 4 decades experience of total knee arthroplasty (TKA), there is still a group of patients who are not satisfied with the outcome. In spite of the improvement of many aspects around the procedure, for unexplainable reasons, patient dissatisfaction is still approximately the same. We conducted this study to analyze correlations between preoperative psychological aspects and dissatisfaction after TKA.

Methods

A total of 186 patients were operated with a primary TKA. Patients filled out the Hospital Anxiety and Depression Scale, Visual Analog Pain Scale (0-100), and Knee injury and Osteoarthritis Outcome Score preoperatively and 4 years postoperatively. Four years postoperatively, the patients also scored their satisfaction degree with the outcome of the surgery.

Results

Of 186 patients, 27 (15%) reported that they were dissatisfied or uncertain with the result of their TKA 4 years postoperatively. Sixteen of those 27 patients had reported anxiety/depression preoperatively compared with 11 of 159 (7%) in the satisfied or very satisfied groups. Patients with preoperative anxiety or depression had more than 6 times higher risk to be dissatisfied compared with patients with no anxiety or depression (P < .001). Patients with deep prosthetic infection had 3 times higher risk to be dissatisfied with the operation outcome (P = .03). Dissatisfied patients had 1-day longer hospital stay compared with the satisfied group (P < .001).

Conclusion

Preoperative anxiety and/or depression is an import predictor for dissatisfaction after TKA. Psychological assessment and treatment preoperatively might improve degree of satisfaction.

Section snippets

Patients and Methods

A total of 186 consecutive TKA patients having primary osteoarthritis were included. We excluded patients having bilateral TKA, dementia, or not being able to speak Swedish. The patients in this study were included in another study regarding the effect of continuous intraarticular analgesia on pain and rehabilitation after TKA [19]. Total number of patients included in that original article were 200, and 14 of these patients were lost during the follow-up period (12 deceased, 2 refused to

Results

Patient characteristics and the overall result are shown in Table 1, Table 2, Table 3. A total of 27 of the 186 patients (15%) reported that they were not satisfied (uncertain or dissatisfied) with the result of their TKA 4 years after surgery. A total of 16 of those 27 patients reported anxiety and/or depression according to the HAD score compared with 11 of 159 (7%) in the satisfied group (satisfied and very satisfied) at the 4-year follow-up. As shown in Table 2, we found that the patients

Discussion

We found in this study that preoperative psychological distress had a significant correlation with patient dissatisfaction 4 years after TKA. In fact, psychological distress, defined as anxiety and/or depression, had the strongest statistical correlation with dissatisfaction 4 years after TKA of all variables studied. The presence of radiographic grade 1 or 2 osteoarthritis according to the Kellgren and Lawrence classification did not correlate with dissatisfaction. Longer postoperative

Acknowledgments

The authors thank Professor Jonas Ranstam, RC Syd, Clinical Sciences, Lund University, for advice on statistics. They are grateful to all the medical staff of the Orthopaedics Department, in Lund and Trelleborg Hospital especially Åsa Björkqvist and Ewa Persson, for excellent cooperation. Ali collected and analyzed the data and prepared the manuscript. All the authors designed the study and helped in writing the manuscript. Ali, Flivik, and Sundberg recruited patients and performed the

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Wound complications following revision TKA can be catastrophic and can compromise joint and even limb. The purpose of this study was to determine the prevalence of superficial wound complications requiring return to the OR in revision TKA, rates of subsequent deep infection, factors that increase the risk of superficial wound complications, and the outcomes of revision TKA following development of superficial wound complications.
We retrospectively reviewed 585 consecutive TKA revisions with at least two years follow-up, including 399 aseptic revisions and 186 reimplantations. Superficial wound complications without deep infection requiring return to the OR within 120 days were compared to controls.
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: One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.08.033.

: The study was partially supported financially by Region Skåne and by the Erik and Angelica Sparre Foundation.

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Primary ArthroplastyPreoperative Anxiety and Depression Correlate With Dissatisfaction After Total Knee Arthroplasty: A Prospective Longitudinal Cohort Study of 186 Patients, With 4-Year Follow-Up

Abstract

Background

Methods

Results

Conclusion

Section snippets

Patients and Methods

Results

Discussion

Acknowledgments

J Arthroplasty

J Arthroplasty

J Arthroplasty

J Arthroplasty

Osteoarthritis Cartilage

Arch Gerontol Geriatr

J Arthroplasty

Knee

Semin Arthritis Rheum

J Arthroplasty

Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients

J Bone Joint Surg Br

Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?

Clin Orthop Relat Res

Patient-reported outcomes after fixed- versus mobile-bearing total knee replacement: a multi-centre randomised controlled trial using the Kinemax total knee replacement

J Bone Joint Surg Br

The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty

Clin Orthop Relat Res

Predicting total knee replacement pain: a prospective, observational study

Clin Orthop Relat Res

Patient outcomes after knee replacement

Clin Orthop Relat Res

Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden

Acta Orthop Scand

Health-related quality of life after knee replacement

J Bone Joint Surg Am

Do psychological factors predict poor outcome in patients undergoing TKA? a systematic review

Clin Orthop Relat Res

Systematic analysis of painful total knee prosthesis, a diagnostic algorithm

Arch Bone Jt Surg

Primary Arthroplasty
Preoperative Anxiety and Depression Correlate With Dissatisfaction After Total Knee Arthroplasty: A Prospective Longitudinal Cohort Study of 186 Patients, With 4-Year Follow-Up