Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland/Bruderholz, 4101, Bruderholz, Switzerland,
Knee Surg Sports Traumatol Arthrosc. 2013 Oct;21(10):2405-11. doi: 10.1007/s00167-013-2409-z. Epub 2013 Jan 29.
Patient-based and psychological factors do influence outcome in patients undergoing total knee arthroplasty (TKA). The purpose was to investigate if preoperative psychological factors influence the subjective and objective outcomes 6 weeks, 4 months and 1 year after TKA. Our hypothesis was that there is a significant influence of psychological factors on clinical outcome scores before and after TKA.
A prospective, longitudinal, single-cohort study investigating the correlation of depression, control beliefs, anxiety and a variety of other psychological factors with outcomes of patients undergoing TKA was performed. A total of 104 consecutive patients were investigated preoperatively using the Beck`s depression inventory, the State-Trait Anxiety Index, the questionnaire for assessment of control beliefs and the SCL-90R inventory. The Knee Society Clinical Rating System (KSS) and the WOMAC were used. Analysis of TKA position was performed on radiographs according to Ewald et al. Correlation of psychological variables with outcomes was performed (p < .05).
Self-efficacy did not influence clinical scores. More depressed patients showed higher pre- and postoperative WOMAC scores, but no difference in amelioration. KSS scores were not influenced. Patients with higher State and Trait Anxiety Indexes had higher WOMAC and lower KSS scores before and after the operation, but most significant correlations were <0.3. Several SCL-90 dimensions had significant correlations with pre- and postoperative clinical scores, but not with their amelioration. The SCL-90 subscore for somatization and the overall SCL-90 significantly correlated with the WOMAC, KSS before and after TKA.
Depression, anxiety, a tendency to somatize and psychological distress were identified as significant predictors for poorer clinical outcomes before and/or after TKA. Standardized preoperative screening and subsequent treatment should become part of the preoperative work-up in orthopaedic practice.
Prognostic prospective, Level I.
患者相关因素和心理因素确实会影响全膝关节置换术（TKA）患者的预后。本研究旨在探讨术前心理因素是否会影响 TKA 术后 6 周、4 个月和 1 年时的主观和客观结局。我们的假设是心理因素对 TKA 前后的临床结局评分有显著影响。
前瞻性、纵向、单队列研究调查了抑郁、控制信念、焦虑和各种其他心理因素与接受 TKA 治疗的患者结局之间的相关性。共对 104 例连续患者进行了术前调查，使用贝克抑郁量表、状态特质焦虑量表、控制信念评估问卷和 SCL-90R 量表。采用膝关节学会临床评分系统（KSS）和 WOMAC 进行评分。根据 Ewald 等人的方法对 TKA 位置进行放射学分析。对心理变量与结局的相关性进行分析（p＜0.05）。
自我效能感不影响临床评分。抑郁程度较高的患者在术前和术后的 WOMAC 评分更高，但改善程度无差异。KSS 评分不受影响。状态和特质焦虑指数较高的患者在手术前后的 WOMAC 和 KSS 评分较低，但相关性最高为＜0.3。多个 SCL-90 维度与术前和术后的临床评分显著相关，但与改善程度无关。躯体化的 SCL-90 亚评分和总体 SCL-90 与 TKA 前后的 WOMAC、KSS 显著相关。
抑郁、焦虑、躯体化倾向和心理困扰被确定为 TKA 前后临床结局较差的显著预测因素。标准化的术前筛查和随后的治疗应成为矫形外科实践中术前评估的一部分。
预后性前瞻性，Ⅰ级。
