Effect of sedation anesthesia on kinesiophobia and early outcomes after total knee arthroplasty

Abstract

Background: Total knee arthroplasty (TKA) operation is an effective treatment method in severe osteoarthritis worldwide. However, the number of patients with chronic pain and functional limitations in the postoperative period will continue to increase. Kinesiphobia is an important factor that affects the functional outcomes postoperatively. The aim of this study is to investigate the effects of intraoperative consciousness of the patients during surgery on kinesiophobia development and early functional outcomes of TKA. Methods: Sixty patients with the diagnosis of primary knee osteoarthritis were enrolled in the study. Tampa Scale of Kinesiophabia (TSK) was obtained for each patient at multiple time periods. Regional anaesthesia and deep sedation were performed on group 1 ( n = 30), while regional anaesthesia and light sedation were performed on group 2 ( n = 30). The same surgical procedures were applied to all participants. Functional tests were performed on the patients at the postoperative 2nd and 5th days. Visual Analogue Scale (VAS) scores and knee flexion angles were also measured postoperatively. Results: The mean age of the participants (19 men (31.7%) and 41women (68.3%)) was 67.7 ± 6.7 (54–82) years. TSK ≥ 40 was detected in 18 (30%) patients preoperatively and 33 patients (55%) postoperatively. The number of kinesiophobic patients showed statistically significant increase after operation (20/30 (66.7%)) according to preoperative period (9/30 (30%)) in group 2 ( p = 0.003). Postoperative functional scores, knee flexion angles and VAS scores were better in non-kinesiophobic patients. Conclusion: Patient’s consciousness during TKA operations is an important factor that interferes with the postoperative kinesiophobia development, which may play a pivotal role affecting the early mobility and functional outcomes.

The effects of kinesiophobia on outcome following total knee replacement: a systematic review

“…The results of the Cochrane Risk of Bias tool is shown in Table 3. Degirmenci et al [31], Monticone et al [6] and Cai et al [32] demonstrated low risk of bias, whereas Russo et al [33] failed to describe how their data were analysed, and whether if it was in accordance with pre-specified analysis plans.…”

“…Russo et al [33] did not specify the gender split and Body Mass Index (BMI) in their study but stated that the two groups were homogenous in terms of pre-operative age, gender, functional and psychological scores. Degirmenci et al [31] did not specify the mean BMI, but stated BMI over 40 in the exclusion criteria. Of 12 studies, 34.9% (380 of 1,089) were men.…”

“…Other outcome measures include pain measured using a Numerical Rating Scale (NRS) or McGill Pain Score (MPS) in studies and flexion or change in ROM in seven studies. Comparison 1: The role of kinesiophobia in outcomes following TKR Primary outcomes: Functional outcomes were assessed by ten studies (Doury-Panchout et al [34], Kocic et al [2], Sullivan et al [35], Sullivan et al [36], Filardo et al [37], Guney-Deniz et al [38], Filardo et al [29], Brown et al [39], Unver et al [30], and Degirmenci et al [31]). The results from these studies are shown in Table 5.…”

“…TSK <39.5 2-MWT were 36.77 (SD 6.04), versus 39.5 plus at 26.42 (SD 5.07), p<0.01, and TUG for TSK <39.5 were 51.91 (range 33.56-59.11) versus 51.99 (range 32.7-58.7) (non-significant). Degirmenci et al [31] measured the 2-MWT and TUGT at days two and five post-surgery, with mean values of day two and five reported, using a TSK cut-point of 40. TSK <40 2-MWT were 36.15 (SD 4.16) versus 40 plus at 25.76 (SD 4.5), p<0.001.…”

“…They correlated TSK with pain at day two post-surgery r = 0.80, p <0.001. Degirmenci et al [31] had a TSK cut-point of 40, and measured pain levels Day post-op using a VAS. TSK <40 had a VAS of 4.2 (SD 0.8) versus TSK 40 plus at 6.6 (SD 0.9), p<0.001.…”