Decrease of Quality of Life, Functional Assessment and Associated Psychological Distress in Patients with Hypoallergenic Total Knee Arthroplasty

Abstract

Total knee arthroplasty (TKA) is the final treatment for knee osteoarthritis, and 15–30% of patients show little or no improvement. This high percentage is related to aspects of the surgical technique, the selected implant, and specific patient characteristics. The aim of this study was to analyze whether there are differences in quality of life (QoL) and functional capacity among patients undergoing TKA with conventional implants compared to those treated with hypoallergenic oxinium implants. A pragmatic clinical study was carried out that included patients who underwent TKA between January 2013 and December 2015. During this period, 245 knees in 228 patients were treated. Eleven patients were excluded, leaving a sample of 161 conventionally treated knees, 72 knees treated with hypoallergenic implants, and one patient who received both implant types. In all patients, QoL and functional capacity were measured with the WOMAC index, the SF-12 questionnaire, and the Euro-Qol-5D L-VAS. We also assessed the psychological distress of each patient and related the findings to the functional results. The differences in QoL were tested using ANCOVA and propensity score matching (PSM) models adjusted for sex, age, weight, psychiatric history and associated complications. Patients who underwent TKA using conventional prostheses had significantly better scores on the total WOMAC index and in the pain domain (p < 0.05) than those who received hypoallergenic prostheses, but no significant differences were observed for the other domains in the ANCOVA. In contrast, with the PSM, we also found statistically significant differences in the difficulty domain of the WOMAC. Significant differences were found for the SF-12 mental health questionnaire results (p = 0.038), but the same did not occur for the physical health domain in the ANCOVA and PSM. We also found statistically significant differences in the Euro-Qol-5D index results (p = 0.041), but not in the VAS scale scores for the same questionnaire in the ANCOVA, and we did not find significant differences in either with the PSM. Patients with metal allergies and those who present psychological distress had WOMAC, SF-12, and Euro-Qol-5D results that were statistically significantly worse than those of patients who received conventional implants. Patients who underwent hypoallergic TKA had lower scores on the QoL and functional capacity scales than patients who received conventional Cr–Co implants. Additionally, patients with psychological distress had worse results on the questionnaires, and those with a metal allergy had even lower scores; the differences were statistically significant.

Sexuality, Quality of Life, Anxiety, Depression, and Anger in Patients with Anal Fissure. A Case–Control Study

“…Previous studies have focused on the relationship between medical diseases or mental disorders including its treatments and patients sexuality, QoL (general or health related), or selected psychological factors highlighting the relationship between these factors and clinical disorders or its treatments [ 5 , 10 , 11 , 13 , 14 , 15 , 19 , 20 , 23 , 25 , 29 , 34 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ]. These include, sex and quality of life [ 10 ]; sexual health and dysfunction in patients with rheumatoid arthritis [ 13 ]; sexuality and mental health [ 15 ]; antipsychotic-related sexual dysfunction [ 19 ]; sexual function in chronic illness [ 20 ]; the impact of physical illness on sexual dysfunction [ 23 ]; sexual dysfunction and chronic illness [ 27 ]; sex and chronic physical illness [ 28 ]; comorbidities in male and female sexual dysfunction [ 60 ]; sexual dysfunction and mental health in patients with multiple sclerosis and epilepsy [ 29 ]; psychiatric disorders and sexual dysfunction [ 63 ]; thyroid autoimmune disease impacting on sexual function in young women [ 64 ]; clinical features associated with female genital mutilation/cutting [ 65 ]; QoL after flatfoot surgery [ 33 ]; anxiety and QoL in patients with type 2 diabetes [ 58 ]; QoL and associated psychological distress in patients with knee arthroplasty [ 59 ]; psychological factors as determinants of medical conditions [ 57 ]; sleep disturbance, depression and anxiety in frail patients with atrial fibrillation [ 61 ]; cognitive behavior counseling in preoperative preparation and enhanced recovery after surgery [ …”

Influence of Psychological Distress in Patients with Hypoallergenic Total Knee Arthroplasty. Treatment Algorithm for Patients with Metal Allergy and Knee Osteoarthritis

“…As the relationship between MA and PD has been reported in the past, we studied how this psychological disorder affects TKA’s outcomes [ 17 ]. Up to one third of the patients with hypoallergenic TKAs have pre-PD, and their results are clearly inferior to those patients with MA without pre-PD.…”

“…Another factor that is related to the outcomes in TKA is the psychological status of the patient. Up to one third of the patients that undergo TKA may have psychological distress (PD) [ 16 , 17 ], a term that encompasses a group of psychological symptoms, including anxiety, depression, and somatization, which affect the outcome of the surgery [ 18 , 19 ]. Due to the complex relationship of both MA and PD and according to the worse outcomes of hypoallergenic implants [ 17 ] previously published by our group, we decided to study what grade of PD is present in the patients that undergo TKA.…”

“…Up to one third of the patients that undergo TKA may have psychological distress (PD) [ 16 , 17 ], a term that encompasses a group of psychological symptoms, including anxiety, depression, and somatization, which affect the outcome of the surgery [ 18 , 19 ]. Due to the complex relationship of both MA and PD and according to the worse outcomes of hypoallergenic implants [ 17 ] previously published by our group, we decided to study what grade of PD is present in the patients that undergo TKA. Our primary objective was to analyse the influence that PD has on the outcomes from the hypoallergenic TKAs, and to try to develop, according to the study results, new algorithms that guide preoperative decision making and, consequently, optimize surgical results.…”

Poor Correlation Among Metal Hypersensitivity Testing Modalities and Inferior Patient-Reported Outcomes After Primary and Revision Total Knee Arthroplasties

“…Studies reporting clinical outcomes after TKAs with hypoallergenic implants for confirmed or suspected metal hypersensitivities have produced conflicting data [ 5 , [12] , [13] , [14] , [17] , [18] , [19] ]. Patients with hypersensitivity confirmed by contact SPT have been shown to have equivalent outcomes to patients with negative SPT receiving the same TKA implants [ 14 ].…”