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

Vikki Wylde, Lea Trela-Larsen, Michael R Whitehouse, Ashley W Blom, Vikki Wylde, Lea Trela-Larsen, Michael R Whitehouse, Ashley W Blom

Abstract

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.

Figures

Figure 1.
Figure 1.
Participant numbers
Figure 2.
Figure 2.
Forest plot of adjusted multiple linear regression results for outcomes at 1 and 5 years. Results shown as effect size estimates with 95% confi dence intervals. Adjusted for preoperative outcome measure and confounders.
Figure 3.
Figure 3.
Predicted WOMAC Pain at each time point for varying levels of Pain Self-effi cacy from mixed effect linear regression models, adjusted for confounders and with an interaction term for pain self-effi cacy. All other covariates were assigned their median values. Higher WOMAC Pain scores indicate lower levels of pain.
Figure 4.
Figure 4.
Predicted AKSS at each time point for varying levels of Pain Self-effi cacy from mixed effect linear regression models, adjusted for confounders and with an interaction term for pain self-effi cacy. All other covariates were assigned their median values. Higher AKSS Knee scores are better.

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