Factors affecting the quality of life after total knee arthroplasties: a prospective study

Abstract

BackgroundThe purpose of the study is to evaluate the self-reported outcomes in the first year after primary total knee arthroplasty (TKA), and to determine factors influencing the quality of life (QoL) 6 weeks, 3, 6, and 12 months after TKA.MethodsA cohort of patients with knee osteoarthritis undergoing primary TKA at two hospitals (a regional university hospital and a capital’s metropolitan hospital) was prospectively followed for 12 months. Patients were assessed preoperatively and at 4 postoperative time-points, with the use of self-reported measurements for pain, physical function and depression with the following evaluation tools: Western Ontario and McMaster Osteoarthritis Index [WOMAC], Knee Society Scoring system [KSS], Centre for Epidemiological Studies Depression Scale, [CES-D10] and visual analog scale [VAS] for pain). General linear modelling for repeated measures was used to evaluate the effect of each independent variable including clinical and sociodemographic data. Differences between groups at different time points were tested by the independent samples t-test.ResultsOf the 224 eligible patients, 204 (162 females, mean age 69.2) were included in the analysis. Response rate at one year was 90%. At 6 weeks after surgery, despite improvement in pain and alleviation of the depressive mood, the physical function remained less satisfactory. Females presented lower scores in terms of quality of life, both preoperatively and 6 weeks after TKA. Significant improvement was already experienced at 3 months postoperatively. According to WOMAC, KSS, CES-D10 and pain VAS scores the Qol was significantly improved 12 months after TKA (P < 0.001). CES-D10 score was positively correlated with WOMAC and pain VAS scores at all the time points assessed (P < 0.001). Age, body mass index (BMI), place of residence, level of education and social support were not significant predictors of QoL after TKA.ConclusionsPatients experienced great improvement in their QoL after TKA in spite of a less satisfactory physical function in the first 6 weeks after surgery, with noticeable differences in the QoL among genders in the same time period. After that period all patients experienced significant improvement for all the measured parameters, until the third postoperative month with smaller changes thereafter.

Do Psychological Factors Predict Poor Outcome in Patients Undergoing TKA? A Systematic Review

“…The remaining six studies did not examine these states specifically but showed that lower preoperative mental health scores had similar postoperative associations [8,9,13,27,46,47,50]. Pain scores in the patient population with anxiety, depression, or lower mental health scores were elevated at baseline and at all assessment points [13,27,28,34,37,47,50] for up to 2 years in one study [34 ]. Lingard and Riddle [34] estimated the effect to be 3 to 5 points lower on the 20-point pain component of the WOMAC, indicating worse pain in the group of patients with lower mental health scores.…”

“…The studies were conducted in seven countries: 10 in the USA [3,5,8,9,13,14,24,34,39,46]; four in the UK [27,34,44,50]; four in Canada; [18,26,34,47]; and one each in Australia [34], Spain [15], Greece [37], and Korea [28]. Most studies (17) were conducted in metropolitan populations; one study was a multinational cohort study conducted in 13 centers in four countries (UK, USA, Australia, and Canada) [34].…”

“…Most studies (17) were conducted in metropolitan populations; one study was a multinational cohort study conducted in 13 centers in four countries (UK, USA, Australia, and Canada) [34]. One study included a rural and metropolitan population [37] and one included only patients from indigent backgrounds [13]. In total, our review reports on studies including 9046 TKAs performed in 8704 patients, of which 5494 (63%) were women.…”

“…Two studies used the Pain Catastrophizing Scale [39,47]. Other psychological assessment tools included the Self-Efficacy Scale [50], Purpose In Life [46], Patient Health Questionnaire [13], Hospital Anxiety and Depression scale [5], and the Centre for Epidemiological Studies Depression scale [37]. The heterogeneity in the use of psychological tools and outcomes precluded data pooling for the purposes of performing a meta-analysis.…”

High Level of Residual Symptoms in Young Patients After Total Knee Arthroplasty

“…Introduction TKA continues to enhance the quality of life and alleviate pain for a large number of patients [10]. This surgical procedure carries such a high success rate that it has become one of the most frequently performed procedures, with more than 600,000 procedures performed in the United States last year alone [8].…”