title: Does preoperative psychologic distress influence pain, function, and quality of life after TKA?
abstract: BACKGROUND
  Preoperative psychologic distress is considered to be a risk factor for clinical dissatisfaction stemming from persistent pain and physical limitations after elective orthopaedic procedures such as lower-extremity arthroplasty. However, the degree to which psychologic distress, specifically in the form of anxiety and depression, influences surgical results has been poorly characterized.
  
  
  OBJECTIVE
  We analyzed the effect of preoperative psychologic distress on changes in pain, function, and quality of life 1 year after elective TKA.
  
  
  METHODS
  In this prospective cohort study, we assessed patients who underwent TKAs in 2009 and 2010. Before surgery, patients completed the Folstein Mini Mental Test, the Hospital Anxiety and Depression Scale (HAD), The Knee Society Score(©), the WOMAC quality-of-life questionnaire, and the VAS for pain. The patients were divided into two groups based on the degree of psychologic distress on the HAD Scale, and the groups were compared in terms of the above-listed clinical outcomes tools 1 year after surgery using multivariate linear models. Two hundred sixty-three patients met the inclusion criteria, and 202 (77%) completed the study protocol.
  
  
  RESULTS
  The presence of preoperative psychologic distress did not influence 1-year postoperative pain assessment (average reduction in pain, 40.33; 95% CI, 36.9-43.8; p = 0.18). The only factor influencing change in pain experienced by patients was the preoperative pain recorded (R(2) = 0.31; β = -0.82; p < 0.001). The patients experiencing preoperative psychologic distress obtained poorer outcomes in function (R(2) = 0.16; β = -5.62; p = 0.001) and quality of life (R(2) = 0.09; β = -0.46; p < 0.001) 1 year after receiving TKA.
  
  
  CONCLUSIONS
  The presence of preoperative psychologic distress is associated with worse 1-year outcomes for function and quality of life in patients undergoing TKA. Interventions designed to reduce psychologic distress may be indicated for patients to undergo this type of surgery, and incorporation of these data into discussions with patients may facilitate informed and shared decision making regarding the surgical treatment of knee osteoarthritis.
  
  
  METHODS
  Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Orthopaedics and Traumatology Department, Guadalajara University Hospital, 19002, Guadalajara, Spain, osnofla2001@yahoo.com.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Utrillas-Compaired
authors.forename: Basilio J
authors.initials: BJ
authors.lastname: De la Torre-Escuredo
authors.forename: Ana J
authors.initials: AJ
authors.lastname: Tebar-Martínez
authors.forename: Ángel
authors.initials: Á
authors.lastname: Asúnsolo-Del Barco
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D001696:Biomechanical Phenomena; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome