Preoperative Determinants of Patient-reported Pain and Physical Function Levels Following Total Knee Arthroplasty: A Systematic Review

Abstract

Background:A sound knowledge of the determinants of total knee arthroplasty (TKA) outcomes could help in patient selection, preparation and education. We aimed to assess the current status of the literature evaluating preoperative determinants of early and medium term patient-reported pain and disability following TKA.Method:A search in Medline, Pubmed, Embase and CINAHL until October 2014 was undertaken. Selection criteria included: 1- participants undergoing primary unilateral TKA with a follow-up from 6 months to 2 years, 2- validated disease-specific patient-reported outcome measures assessing pain and/or function used as outcome measure and 3- identification of preoperative determinants obtained via multivariate analyses. Risk of bias was assessed using a modified version of the Methodology checklist for prognostic studies. Results:Thirty-three prognostic explanatory studies were included. Mean total score of the methodological quality was 80.7±12.2 %. Sociodemographic and psychosocial determinants included greater socioeconomic deprivation (both studies), greater levels of depression and/or anxiety (7 out of 10 studies) and greater preoperative pain catastrophizing (all 3 studies). Significant clinical determinants included worse pre-operative knee related pain or disability (20 out of 22 studies), presence or greater levels of comorbidity (12 out of 23 studies), back pain (4 out of 5 studies) and lower general health (all 11 studies). Conclusion:Several significant determinants of short to medium-term pain and functional outcomes following TKA have been summarized by studies with moderate-to-high methodological quality. No conclusions can be reached regarding the strength of the associations between significant determinants and TKA results because of heterogeneity of study methodologies and results. Further high-quality research is required.

Does Education Level Mitigate the Effect of Poverty on Total Knee Arthroplasty Outcomes?

“…In poor communities, those with some college education achieve significantly better WOMAC scores than those without college education, whereas in wealthy communities, college education provides little additional benefit. Although the impact of poverty and low educational attainment on TKA outcomes has been previously described, (24–28), this is the first study to describe the interaction between community poverty and education as it impacts TKA outcomes.…”

The psychological features of patellofemoral pain: a systematic review

“…The psychological factors identified therein included catastrophising,57–61 depression58–60 and anxiety 60. In other knee conditions, psychological factors also seem to share a relationship with function.…”

External Validation of a Prognostic Model for Predicting Nonresponse Following Knee Arthroplasty

“…For example, instruments designed to quantify pain catastrophizing, anxiety and depressive symptom severity may provide more granular and therefore more stable and more predictive measures of psychological health [23]. Contralateral knee OA and pain status [24] as well as index knee quadriceps strength[25], fibromyalgia symptoms[26] and overall bodily pain also have been associated with poor outcome following KA and may add to the power of a prognostic model.…”