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FOTO Rehab Outcomes Blog

Will Preoperative Anxiety Affect Outcomes after Total Knee Arthroplasty?

There has been a recent abundance of research focused on psychosocial factors. In quite a few cases, these factors may be predictive of outcomes. 

What do you think? Do you think preoperative psychosocial factors affect outcomes after a total knee arthroplasty?

Over the last few years more attention has been given to psychosocial factors. We are really focusing on how depression, anxiety, catastrophizing, pain self-efficacy and social support affect outcomes of care.  For individuals who have low back pain, the STarT back screening tool is used to stratify care.  Social determinants of health are the new factors being analyzed to determine if they affect outcomes. 

How much should you worry when patients coming to you have quite a few psychosocial factors when they see you post operatively after a total knee arthroplasty? The good news is that in the long term, these factors have little impact in the long term. In this study, only one psychosocial factor stood out as affecting the outcome 1 year after surgery. By year 5, there was no difference between patients. 

As I think about this, it seems FOTO has again surpassed the norm. In 2017 FOTO improved the risk adjustment process to have more accurate predictions on the outcomes of care. The improvement lies in the fact that the FOTO Research Advisory Board worked at analyzing data to learn if various patient factors had the same level of affect on outcomes. As seen in this research study, anxiety was the only factor that had an impact 1 year post operatively. This means that the other factors analyzed would have no effect on outcomes. The other factors should not be considered risk adjustment factors for someone who just had a total knee arthroplasty. The FOTO Research Advisory Board is the first group that I am aware of that has individualized the risk adjustment process to include only the factors that affect the particular impairment. 

Below you will find a quick view of the abstract.



Preoperative psychosocial risk factors for poor outcomes at 1 and 5 years after total knee replacement.



Background and purpose - Psychosocial factors are important risk factors for poor outcomes in the first year after total knee replacement (TKR), however their impact on long-term outcomes is unclear. We aimed to identify preoperative psychosocial risk factors for poor outcomes at 1 year and 5 years after TKR.

Patients and methods - 266 patients were recruited prior to TKR surgery. Knee pain and function were assessed preoperatively and at 1 and 5 years postoperative using the WOMAC Pain score, WOMAC Function score and American Knee Society Score (AKSS) Knee score. Preoperative depression, anxiety, catastrophizing, pain self-efficacy and social support were assessed. Statistical analyses involved multiple linear regression and mixed effect linear regression.

Results - Higher anxiety was a risk factor for worse pain at 1 year postoperative. No psychosocial factors were associated with any outcomes at 5 years postoperative. Analysis of change over time found that patients with higher pain self-efficacy had lower preoperative pain and experienced less improvement in pain up to 1 year postoperative. Higher pain self-efficacy was associated with less improvement in the AKSS up to 1 year postoperative but more improvement between 1 and 5 years postoperative.

Interpretation - Preoperative anxiety was found to influence pain at 1 year after TKR. However, none of the psychosocial variables were risk factors for a poor outcome at 5 years post-operative, suggesting that the negative effects of anxiety on outcome do not persist in the longer-term.

 2017 Oct;88(5):530-536. doi: 10.1080/17453674.2017.1334180. Epub 2017 May 31.