Psychosocial Determinants of Total Knee Arthroplasty Outcomes Two Years After Surgery

López-Olivo, María A.; Ingleshwar, Aparna; Landon, Gene; Siff, Sherwin J.; Barbo, Andrea G.; Lin, Heather; Suarez‐Almazor, María E.

doi:10.1002/acr2.11178

Cited by 10 publications

(4 citation statements)

References 50 publications

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“…Our finding that higher ADI scores were associated with not achieving PASS thresholds for KOOS pain and KOOS JR scores at 1 year postoperatively is consistent with reports that lower socioeconomic deprivation is associated with decreased patient-reported outcome scores [12, 14]. Our findings suggest that patients from areas with higher socioeconomic deprivation may have a worse perception of their surgical outcomes.…”

Section: Discussionsupporting

confidence: 90%

High Area Deprivation Index is Associated With Not Achieving the Patient-acceptable Symptom State After TKA

Hadad,

Pasqualini,

Klika

et al. 2024

Clin Orthop Relat Res

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Background The Area Deprivation Index (ADI) approximates a patient’s relative socioeconomic deprivation. The ADI has been associated with increased healthcare use after TKA, but it is unknown whether there is an association with patient-reported outcome measures (PROMs). Given that a high proportion of patients are dissatisfied with their results after TKA, and the large number of these procedures performed, knowledge of factors associated with PROMs may indicate opportunities to provide support to patients who might benefit from it. Questions/purposes (1) Is the ADI associated with achieving the minimum clinically important difference (MCID) for the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain, Joint Replacement (JR), and Physical Function (PS) short forms after TKA? (2) Is the ADI associated with achieving the patient-acceptable symptom state (PASS) thresholds for the KOOS pain, JR, and PS short forms? Methods This was a retrospective study of data drawn from a longitudinally maintained database. Between January 2016 and July 2021, a total of 12,239 patients underwent unilateral TKA at a tertiary healthcare center. Of these, 92% (11,213) had available baseline PROM data and were potentially eligible. An additional 21% (2400) of patients were lost before the minimum study follow-up of 1 year or had incomplete data, leaving 79% (8813) for analysis here. The MCID is the smallest change in an outcome score that a patient is likely to perceive as a clinically important improvement, and the PASS refers to the threshold beyond which patients consider their symptoms acceptable and consistent with adequate functioning and well-being. MCIDs were calculated using a distribution-based method. Multivariable logistic regression models were created to investigate the association of ADI with 1-year PROMs while controlling for patient demographic variables. ADI was stratified into quintiles based on their distribution in our sample. Achievement of MCID and PASS thresholds was determined by the improvement between preoperative and 1-year PROMs. Results After controlling for patient demographic factors, ADI was not associated with an inability to achieve the MCID for the KOOS pain, KOOS PS, or KOOS JR. A higher ADI was independently associated with an increased risk of inability to achieve the PASS for KOOS pain (for example, the odds ratio of those in the ADI category of 83 to 100 compared with those in the 1 to 32 category was 1.34 [95% confidence interval 1.13 to 1.58]) and KOOS JR (for example, the OR of those in the ADI category of 83 to 100 compared with those in the 1 the 32 category was 1.29 [95% CI 1.10 to 1.53]), but not KOOS PS (for example, the OR of those in the ADI category of 83 to 100 compared with those in the 1 the 32 category was 1.09 [95% CI 0.92 to 1.29]). Conclusion Our findings suggest that social and economic factors are associated with patients’ perceptions of their overall pain and function after TKA, but such factors are not associated with patients’ perceptions of their improvement in symptoms. Patients from areas with higher deprivation may be an at-risk population and could benefit from targeted interventions to improve their perception of their healthcare experience, such as through referrals to nonemergent medical transportation and supporting applications to local care coordination services before proceeding with TKA. Future research should investigate the mechanisms underlying why socioeconomic disadvantage is associated with inability to achieve the PASS, but not the MCID, after TKA. Level of Evidence: Level III, therapeutic study.

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Section: Discussionsupporting

confidence: 90%

High Area Deprivation Index is Associated With Not Achieving the Patient-acceptable Symptom State After TKA

Hadad,

Pasqualini,

Klika

et al. 2024

Clin Orthop Relat Res

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“… 32 Social support has previously been linked to pain through behavioral and neuroendocrine mechanisms. 22 Our findings on the relationship between social support and pain unpleasantness were surprising since recovery in the postdischarge period was expected to depend more on levels of social support from friends and family members than in the acute phase while still being at the hospital. Our results may be better explained as another example of an expectancy effect: women who expect to receive social support may be less stressed and have lower levels of inflammation and pain sensitivity 28 whether or not they call on that support.…”

Section: Discussionmentioning

confidence: 69%

Acute and subacute postsurgical pain in women with breast cancer: incidence and associations with biopsychosocial predictors—a secondary analysis of a randomized controlled trial

Munk

Jacobsen

Schnur

et al. 2023

PR9

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“…It is known that general physical well-being affects satisfaction in patients following TKA [46]. Furthermore, psychological factors, such as tangible support, depression, dysfunctional coping, and low optimism, are associated with higher pain and inferior results in functionality as well as patient satisfaction after TKA [47]. Hence, we interpret this as growing evidence that well-being, including physical and mental components, appears to play a more important role than previously thought.…”

Section: Discussionmentioning

confidence: 69%

Local Periarticular Infiltration with Dexmedetomidine Results in Superior Patient Well-Being after Total Knee Arthroplasty Compared with Peripheral Nerve Blocks: A Randomized Controlled Clinical Trial with a Follow-Up of Two Years

Reinbacher,

Schittek,

Draschl

et al. 2023

JCM

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Background: This study aimed to compare local periarticular infiltration (LIA) with ultra-sound guided regional anesthesia (USRA) with ropivacaine and dexmedetomidine as an additive agent in primary total knee arthroplasty (TKA). Methods: Fifty patients were randomized into two groups in a 1:1 ratio. Patients in the LIA group received local periarticular infiltration into the knee joint. The USRA group received two single-shot USRA blocks. Functional outcomes and satisfaction (range of movement, Knee Society Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Knee Score, and Forgotten Joint Score), including well-being, were analyzed preoperatively and at five days, six weeks, and one and two years postoperatively. Results: Functional outcomes did not significantly differ between the two groups at six weeks and one and two years after the implementation of TKA. A moderate correlation was observed in the LIA group regarding well-being and pain on day five. Six weeks postoperatively, the LIA group showed significantly superior well-being but worse pain scores. No differences between the groups in well-being and functional outcomes could be observed one and two years postoperatively. Conclusion: Patients treated with LIA had superior postoperative well-being in the early postoperative phase of up to six weeks. Furthermore, LIA patients had similar functionality compared to patients treated with USRA but experienced significantly more pain six weeks postoperatively. LIA leads to improved short-term well-being, which is potentially beneficial for faster knee recovery. We believe that LIA benefits fast-track knee recovery with respect to improved short-term well-being, higher practicability, and faster application.

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Psychosocial Determinants of Total Knee Arthroplasty Outcomes Two Years After Surgery

Cited by 10 publications

References 50 publications

High Area Deprivation Index is Associated With Not Achieving the Patient-acceptable Symptom State After TKA

High Area Deprivation Index is Associated With Not Achieving the Patient-acceptable Symptom State After TKA

Acute and subacute postsurgical pain in women with breast cancer: incidence and associations with biopsychosocial predictors—a secondary analysis of a randomized controlled trial

Local Periarticular Infiltration with Dexmedetomidine Results in Superior Patient Well-Being after Total Knee Arthroplasty Compared with Peripheral Nerve Blocks: A Randomized Controlled Clinical Trial with a Follow-Up of Two Years

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