Anxiety is the cause of the worse outcomes of allergic patients after total knee arthroplasty

Abstract

Purpose The presence of allergies has been proposed as a risk factor for worse outcomes in total knee arthroplasty surgery. The aim of this study is to evaluate if the presence of some psychiatric disorders is more frequent in patients who report allergies and if they could be the main cause for the worse outcomes. Methods A prospective study, including patients undergoing a primary total knee arthroplasty, was designed. In the preoperative visit, all the patients completed a questionnaire about the presence of allergies and also psychiatric tests for anxiety (State‐Trait Anxiety Inventory–STAI‐), depression (Remission from Depression Questionnaire–RDQ‐), somatization disorder (Patient Health Questionnaire‐15–PHQ‐15‐), pain catastrophizing syndrome (Pain Catastrophizing Scale–PCS), and personality disorder (Reduced NEO‐Inventory of Five Factors–NEO‐FFI‐). In the preoperative and at 6 months of follow up, the functional results of the surgery were assessed by the WOMAC, the SF‐12, and the KSS scores. Results A total of 209 patients was included: 136 (65%) did not have reported allergies and 73 (35%) did report some allergies. The psychiatric questionnaires showed that the presence of anxiety was more prevalent in the group of patients with reported allergies (STAI‐T: no allergies 24.08 points vs. allergies 19.18 points, p = 0.039). When comparing the functional outcomes at 6 months of follow up, most of the analyzed scores improved less in the group of patients with reported allergies than in the no allergy‐referred group: WOMAC‐total score (34.37 vs. 40.10 points, p = 0.023), WOMAC‐pain score (6.03 vs. 7.50 points, p = 0.018), WOMAC‐function score (22.97 vs. 27.24 points, p = 0.023), KSS‐knee score (25.37 vs. 33.79 points, p = 0.002), and SF‐12 physical score (7.89 vs. 11.15 points, p = 0.046). The significance of the difference in the outcomes scores in this group was lost after adjusting for anxiety (p > 0.05). Conclusion Allergies reported by patients are confirmed as a risk factor for worse results after TKA surgery. The relationship with anxiety disorder seems to explain the association between self‐reported allergies and sub‐optimal outcomes. Level of evidence II.

Self-reported allergies correlate with a worse patient-reported outcome after hip arthroscopy: a matched control study

“…Prior published literature in total joint arthroplasty has suggested psychological factors can influence postoperative satisfaction rates [ 12 , 13 , 16 ]. Patients who feel a sense of compromised physical or mental wellness are more likely to have worse patient-reported outcomes [ 12 , 13 , 16 ].…”

“…Prior published literature in total joint arthroplasty has suggested psychological factors can influence postoperative satisfaction rates [ 12 , 13 , 16 ]. Patients who feel a sense of compromised physical or mental wellness are more likely to have worse patient-reported outcomes [ 12 , 13 , 16 ]. Further, a correlation between poorer surgical outcomes and patients with symptoms of depression and anxiety [ 16–18 ] or those with negative feelings towards surgery [ 19 ] has been established in both arthroplasty and arthroscopy.…”

Die Anwendung antiallergisch beschichteter Knieendoprothesen ist mittelfristig sicher

“…Dabei sind jedoch in Deutschland die Patienten zwingend auf die Möglichkeit der Verwendung von Alternativmaterialien hinzuweisen und deren Zustimmung zur Verwendung einer Standardprothese zu dokumentieren [39]. Diese Zustimmung wird bei vielen Patienten nicht erzielt werden können, da Allergiepatienten häufig unter Angststörungen leiden [6,23]. Insofern ist für diese Patienten ein hypoallergenes Implantat notwendig.…”

“…Die Ursachen für diese höheren Revisionsraten trotz theoretisch besserer Abriebeigenschaften sind unklar. In der Literatur finden sich jedoch Hinweise, dass Patienten mit und ohne Allergie gegen Implantatmaterialien nicht die gleichen Voraussetzungen aufweisen und somit Allergiepatienten von vornherein ein höheres Revisionsrisiko haben [6,10,22,23]. Insofern kann die Sicherheit einer Implantatbeschichtung nur an vergleichbaren Patienten beurteilt werden, was in dieser Arbeit erfolgt ist.…”

“…Dies wird einerseits mit dem unsicheren Zusammenhang zwischen Kontaktallergie und Gelenkreaktion begründet, andererseits wird dabei aber auch die Sorge vor möglichen negativen Effekten wie Abplatzen der Beschichtung deutlich [8,24,35]. Solche negativen Effekte konnten in der vorliegenden Studie mit mittel- tienten häufig psychologische Auffälligkeiten [6,23]. Deren Zweifel sollten Chirurgen begegnen [22].…”