Background/Purpose: To explore potential psychosocial and demographic factors that influence Total Knee Arthroplasty (TKA) outcomes and satisfaction at 24 months.

Methods: A prospective cohort study was conducted. Outcome measures of interest were: WOMAC and SF-36 recorded at baseline and 24 months post-surgery, and SkiP, recorded at 24 months.  Independent variables included: the Medical Outcome Study–Social Support Scale (MOS-SSS); Depression, Anxiety and Stress scale (DASS); brief COPE inventory; Health Locus of Control (MHLC); Arthritis Self-efficacy Scale (ASES) and the Life Orientation Test–revised (LOT). Spearman rank correlations between baseline predictors and outcomes at 24 months were calculated. Stepwise multiple linear regression was performed to determine the influence of various patient psychosocial domain characteristics at baseline, on the outcomes at 24 months.  For each outcome, a model that considered the baseline outcome measure as one of the predictors and a model that did not consider this were run.  Patient’s age and sex were forced into all models.

Results: There were 178 TKA patients who had baseline and 24 month scores. Patients’ mean age was 65±9 years; 65% were women. Results from the bivariate correlations between psychosocial and demographic characteristics, and outcomes at 24 months showed that; only problem-solving coping, emotional coping and the belief that others have control over one’s health were not significantly correlated with any of the outcomes of interest (p>0.05). Regression analyses with baseline outcomes adjustment indicated that; older age, higher BMI, less tangible support, and lower optimism were associated with worse pain and function scores (total adjusted R²: pain=0.15 and function=0.21). Older age, higher BMI and a greater number of comorbidities was associated with lower PCS domain scores (total adjusted R²= 0.33); whereas being depressed (p<0.001) and having lower optimism (p<0.001) was associated with reduced MCS scores (total adjusted R²= 0.43). Being employed (p<0.001) and less dysfunctional coping (p=0.01) was associated with greater satisfaction with knee procedure (total adjusted R²: 0.12). Similar results were obtained in the models without baseline outcomes adjustment except for MCS component scores wherein; increased BMI (p=0.04), greater number of comorbidities (p=0.03), lower tangible support (p=0.03) and higher stress (p=0.03) was associated with lower MCS scores (total adjusted R²= 0.43).

Conclusion: Psychosocial factors such as; level of tangible support, depression, problem-solving coping, dysfunctional coping and optimism were associated with pain, function and satisfaction in patients after TKA. Thus, in order to achieve clinical success following TKA, physicians must also consider their patients’ psychosocial status. Further research is needed to study suitable intervention strategies targeting these identified psychosocial determinants.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/psychosocial-determinants-of-total-knee-arthroplasty-outcomes-2-years-after-surgery/