Pre- and Post-operative Pain Catastrophizing and Resilience of Patients With Total Knee Arthroplasty: A Cohort Study

Abstract

BackgroundPatients undergoing total knee arthroplasty (TKA) have psychological comorbidities that influence recovery and functional outcomes. Resilience is a psychological construct defined as an individual's ability to adapt to adversity. Pain catastrophizing encompasses rumination, magnification, and helplessness that patients feel toward their pain. Pain catastrophizing is associated with poor function following surgery. Studies assessing the influence of resilience on postoperative outcomes have shown inconsistent findings and have not accounted for the influence of pain catastrophizing. We sought to identify (1) whether baseline pain catastrophizing and resilience are predictive of postoperative knee function, general physical health, and general mental health three months after TKA and (2) whether baseline pain catastrophizing and resilience are associated with preoperative knee function, general physical health, and general mental health.MethodsPatients undergoing TKA between January 2019 and November 2019 were included in this longitudinal cohort study. Demographics and questionnaires [Brief Resilience Scale (BRS), Pain Catastrophizing Scale (PCS), Knee injury and Osteoarthritis Outcome Score, Junior (KOOS, JR.) and Patient-Reported Outcomes Measurement Information System Physical and Mental Health (PROMIS PH and MH, respectively)] were collected preoperatively and 3 months postoperatively. Multivariable regression was used to test associations of preoperative BRS and PCS with postoperative outcomes.ResultsThe study cohort included 117 patients with a median age of 67.0 years (Q1-Q3: 59.0-72.0). Fifty-three percent of patients were women and 70.1% were white. In multivariable linear regression analyses, baseline pain catastrophizing did not demonstrate a significant association with postoperative 3-month knee function, (β = -0.08, p = 0.543), general physical health (β = -0.11, p = 0.313), or general mental health (β = 0.01, p = 0.919). Baseline resilience positively associated with postoperative knee function (β = 0.24, p = 0.019) and general physical health (β = 0.24, p = 0.013).ConclusionsOur prospective analysis suggests that resilience predicts postoperative knee function and general physical health in patients undergoing TKA. Given the inconsistent findings in this area of research, future studies should continue to delineate preoperative constructs that impact patients following surgery. Exploring interventions targeting the preoperative mental health of patients undergoing TKA may improve outcomes in this cohort.