Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science




Laura Witte


Purpose: The purpose of this article is to discuss psychosocial conditions that affect patient outcomes after total knee arthroplasty. Suggestions will be examined regarding methods to identify these disorders preoperatively to improve postoperative satisfaction, in addition to optimization of treatment for these conditions peri-operatively.

Method: A PubMed literature search was conducted with the search terms total knee arthroplasty, knee osteoarthritis, predictors, outcome, depression, anxiety, pain catastrophizing, kinesiophobia, and patient-reported outcome measures. PubMed was the primary source 43 articles were chosen as potential references. The most prevalent psychosocial conditions affecting surgical outcomes, patient-reported measurement tools, and interventions to improve outcomes were identified. An attempt to cite the most recent publications was made, however a small portion of the articles referenced data that was collected over five years ago.

Results: Evidence-based research has identified psychosocial predictors of total knee arthroplasty outcomes. Once preoperative screening tools and perioperative interventions are optimized, additional research can be conducted to determine the effectiveness of these on patient-reported outcomes.

Conclusion: Total knee arthroplasty is an operative procedure used to treat end-stage osteoarthritis. Past literature has demonstrated up to a 20% dissatisfaction rate postoperatively, and researchers have identified physical and psychosocial conditions that negatively affect outcomes. Psychosocial disorders such as anxiety, pain catastrophizing behavior, kinesiophobia, and depression are most commonly discussed in the literature, therefore identification and treatment could result in improving outcomes. Definitions of these are demonstrated in Table 1. Preoperative screening tools for orthopaedists that are developed and utilized, in addition to interventions to provide treatment and/or coping mechanisms for the disorders are recommended to reduce the percentage of patients with poorer postoperative satisfaction.


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