Sex‐Modified Effects of Depression, Low Back Pain, and Comorbidities on Pain After Total Knee Arthroplasty for Osteoarthritis

Abstract

Objective. The influence of sex on post-total knee arthroplasty (TKA) outcomes has been variable in the literature. Though sex is often reported as an averaged effect, we undertook this study to investigate whether sex modified the influence of presurgery characteristics on post-TKA knee pain.Methods. This was a prospective study with data derived from 477 TKA osteoarthritis patients (279 women, 198 men). Questionnaires were completed presurgery and at 3 months postsurgery. The association between 3-month post-TKA knee pain and presurgery covariates (body mass index, comorbidity count, symptomatic joint count, low back pain, knee pain, and depressive symptoms) was assessed by linear regression. Sex-specific effects were evaluated using interactions.Results. Women had significantly worse presurgery knee pain, joint count, and depressive symptoms, and worse postsurgery knee pain, than men. With simple covariate adjustment, no sex effect on pain was found. However, sex was found to moderate the effects of comorbidities (worse for women [P = 0.013]), presence of low back pain (worse for men [P = 0.003]), and depressive symptoms (worse for men [P < 0.001]) on postsurgery pain. Worse presurgery pain was associated with worse postsurgery pain similarly for women and men.Conclusion. The influence of some patient factors on early post-TKA pain cannot be assumed to be the same for women and men; average effects may mask underlying associations. Results suggest a need to consider sex differences in understanding TKA outcomes, which may have important implications for prognostic tool development in TKA.

Association of depressive symptoms and risk of knee pain: the moderating effect of sex

“…Nevertheless, sex was often controlled as a confounder in the analytic models in previous studies [ 51 ]. To date, research on sex differences in the relationship between depressive symptoms and future knee pain was relatively lacking.…”

“…To date, research on sex differences in the relationship between depressive symptoms and future knee pain was relatively lacking. Perruccio et al [ 51 ] examined the influence of depressive symptoms on post-total knee arthroplasty (TKA) pain among TKA patients. They found that sex moderated the effect of depressive symptoms on post-surgery knee pain, with a more significant effect being observed for males than for females [ 51 ].…”

Knee orthopedics as a template for the temporomandibular joint

“…For example, women report more pain before and after total knee arthroplasty when compared to men. 74 Similarly, the percentage of women reporting orofacial pain at routine dental visits was triple that of men. 75 Although some have focused on psychosocial factors to explain this difference, [76][77][78] it is important to consider the ample evidence showing that women's analgesic response is physiologically different from men's.…”

Reduction of Opioid Use With Enhanced Recovery Program for Total Knee Arthroplasty

“…In a recent study by Perruccio and colleagues, sex was found to moderate the effects of comorbidities, low back pain, and depressive symptoms on postoperative pain in patients undergoing TKA. 30 With regard to outpatient narcotic prescriptions, although we cannot fully know whether these filled prescriptions were used for pain control, it is a reasonable assumption that patients who are dealing with continued postoperative or chronic pain issues will fill these prescriptions or seek refills. It is important to note that the data on prescriptions and refills in the 3-month postoperative period include all narcotic prescriptions filled by any VHA prescriber and are not specifically limited to our orthopedic team.…”