title: Primary total knee replacement in patients with mental disability improves their mental health and knee function: a prospective study.
abstract: We assessed the effect of mental disability on the outcome of total knee replacement (TKR) and investigated whether mental health improves post-operatively. Outcome data were prospectively recorded over a three-year period for 962 patients undergoing primary TKR for osteoarthritis. Pre-operative and one year Short-Form (SF)-12 scores and Oxford knee scores (OKS) were obtained. The mental component of the SF-12 was stratified into four groups according to level of mental disability (none ≥ 50, mild 40 to 49, moderate 30 to 39, severe < 30). Patients with any degree of mental disability had a significantly greater subjective physical disability according to the SF-12 (p = 0.06) and OKS (p < 0.001). The improvement in the disease-specific score (OKS) was not affected by a patient's mental health (p = 0.33). In contrast, patients with mental disability had less of an improvement in their global physical health (SF-12) (p < 0.001). However, patients with any degree of mental disability had a significant improvement in their mental health post-operatively (p < 0.001). Despite a similar improvement in their disease-specific scores and improvement in their mental health, patients with mental disability were significantly more likely to be dissatisfied with their TKR at one year (p = 0.001). Patients with poor mental health do benefit from improvements in their mental health and knee function after TKR, but also have a higher rate of dissatisfaction.
authors: University of Edinburgh, Department of Orthopaedics, The Royal Infirmary of Edinburgh, Little France, Old Dalkeith Road, Edinburgh EH16 4SU, UK. nickclement@doctors.org.uk
authors: N D
authors: ND
authors: Clement
authors: D
authors: D
authors: MacDonald
authors: R
authors: R
authors: Burnett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000502:physiology / Q000601:surgery; D016014:Linear Models; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000523:psychology; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D020370:Osteoarthritis, Knee / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome