Stephanie R Filbay1, Andrew Judge2, Antonella Delmestri3, Nigel K Arden1. 1. Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford UK. 2. Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, Bristol, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK. 3. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford UK.
Abstract
BACKGROUND: One-in-five patients are dissatisfied following knee arthroplasty and <50% have fulfilled expectations. The relationship between knee-arthroplasty expectations and surgical outcome remains unclear. PURPOSE: Are expectations regarding the impact of pain on postoperative life predictive of one-year outcome? Does the impact of pain on preoperative quality of life (QOL) influence this relationship? METHODS: Longitudinal cohort of 1044 uni-compartmental (43%) or total knee-arthroplasty (57%) (UKA or TKA) patients, aged mean 69 ± 9 years. Preoperatively, patients reported the impact of pain on QOL and expected impact of pain on life one-year post-arthroplasty. One-year postoperative outcomes: non-return to desired activity, surgical dissatisfaction, not achieving Oxford Knee Score minimal important change (OKS <MIC). Logistic regression including covariates was performed for all patients and subgroups (better vs worse pre-operative pain-related QOL; UKA vs TKA). RESULTS: Expecting moderate-to-extreme pain (vs no pain) predicted non-return to activity (odds ratio [95% confidence interval], 2.3 [1.3, 4.1]), dissatisfaction (4.0 [1.7, 9.3]), OKS <MIC (3.1 [1.5, 6.3]). Expecting mild pain (vs no pain) predicted worse outcomes for patients with better preoperative pain-related QOL (non-return to activity: 2.7 [1.5, 4.8], OKS <MIC: 2.5 [1.1, 5.5]). Expecting moderate-to-extreme pain (vs. no pain) predicted worse outcomes for patients with worse preoperative pain-related QOL (non-return to activity: 2.4 [1.1, 5.5], dissatisfaction: 5.0 [1.7, 14.8], OKS <MIC: 3.4 [1.4, 8.6]). The odds of a poor outcome in people with worse expectations was higher for UKA patients. CONCLUSIONS: Expecting a worse outcome predicted surgical dissatisfaction, less clinical improvement and non-return to desired activity. Patients expecting a more optimistic outcome relative to preoperative status achieved better surgical outcomes.
BACKGROUND: One-in-five patients are dissatisfied following knee arthroplasty and <50% have fulfilled expectations. The relationship between knee-arthroplasty expectations and surgical outcome remains unclear. PURPOSE: Are expectations regarding the impact of pain on postoperative life predictive of one-year outcome? Does the impact of pain on preoperative quality of life (QOL) influence this relationship? METHODS: Longitudinal cohort of 1044 uni-compartmental (43%) or total knee-arthroplasty (57%) (UKA or TKA) patients, aged mean 69 ± 9 years. Preoperatively, patients reported the impact of pain on QOL and expected impact of pain on life one-year post-arthroplasty. One-year postoperative outcomes: non-return to desired activity, surgical dissatisfaction, not achieving Oxford Knee Score minimal important change (OKS <MIC). Logistic regression including covariates was performed for all patients and subgroups (better vs worse pre-operative pain-related QOL; UKA vs TKA). RESULTS: Expecting moderate-to-extreme pain (vs no pain) predicted non-return to activity (odds ratio [95% confidence interval], 2.3 [1.3, 4.1]), dissatisfaction (4.0 [1.7, 9.3]), OKS <MIC (3.1 [1.5, 6.3]). Expecting mild pain (vs no pain) predicted worse outcomes for patients with better preoperative pain-related QOL (non-return to activity: 2.7 [1.5, 4.8], OKS <MIC: 2.5 [1.1, 5.5]). Expecting moderate-to-extreme pain (vs. no pain) predicted worse outcomes for patients with worse preoperative pain-related QOL (non-return to activity: 2.4 [1.1, 5.5], dissatisfaction: 5.0 [1.7, 14.8], OKS <MIC: 3.4 [1.4, 8.6]). The odds of a poor outcome in people with worse expectations was higher for UKA patients. CONCLUSIONS: Expecting a worse outcome predicted surgical dissatisfaction, less clinical improvement and non-return to desired activity. Patients expecting a more optimistic outcome relative to preoperative status achieved better surgical outcomes.
Authors: José M Quintana; Antonio Escobar; Inmaculada Arostegui; Amaia Bilbao; Jesús Azkarate; J Ignacio Goenaga; Juan C Arenaza Journal: Arch Intern Med Date: 2006-01-23
Authors: Bailey A Dyck; Michael G Zywiel; Anisah Mahomed; Rajiv Gandhi; Anthony V Perruccio; Nizar N Mahomed Journal: Expert Rev Med Devices Date: 2014-05-03 Impact factor: 3.166
Authors: Marta Gonzalez Sáenz de Tejada; Antonio Escobar; Carmen Herrera; Lidia García; Felipe Aizpuru; Cristina Sarasqueta Journal: Value Health Date: 2010-01-15 Impact factor: 5.725
Authors: Natalie J Collins; Devyani Misra; David T Felson; Kay M Crossley; Ewa M Roos Journal: Arthritis Care Res (Hoboken) Date: 2011-11 Impact factor: 4.794
Authors: Brandon C Cabarcas; Alexander Beletsky; Joseph Liu; Anirudh K Gowd; Brandon J Manderle; Matthew Cohn; Nikhil N Verma Journal: Arthrosc Sports Med Rehabil Date: 2021-05-29
Authors: Brian J Lin; Tina Zhang; Ali Aneizi; Leah E Henry; Patrick Mixa; Alexander J Wahl; Keyan Shasti; Sean J Meredith; R Frank Henn Journal: J Orthop Date: 2021-04-01