Resilience and recovery from total knee arthroplasty (TKA): a pathway for optimizing patient outcomes.

Identifying and promoting resilience factors may offer novel strategies for optimizing the recovery of patients following orthopedic surgery. Prior research has suggested that self-efficacy, positive affect, vigor, and vitality may function as resilience factors in the face of chronic pain. The present study examines these resilience factors in a prospective, cognitive-affective-behavioral pathway to recovery. Patients (n = 110) undergoing unilateral, total knee replacement surgery completed self-report assessments of study variables. Self-efficacy was assessed 2 ½ weeks prior to surgery, positive affect the day after surgery, vitality and vigor one-month following surgery, and post-operative pain at one- and three-months following surgery. Control variables included gender, pain, and depressive symptoms prior to surgery. Path analysis revealed significant coefficients from pre-operative self-efficacy to positive affect during hospitalization (β = .246, p = .017), as well as to vitality (β = .323, p = .001) and vigor (β = .387, p < .001) at one-month following surgery. Both indicators of energy predicted better post-operative recovery (one-month: vitality β = -.254, p = .016; vigor β = -.329, p = .002); three-months: vitality β = -.192, p = .047, vigor β = -.201, p = .044). Findings support a cognitive-affective-behavioral pathway to recovery.