Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Arthroplasty. 2021 Apr;36(4):1277-1283. doi: 10.1016/j.arth.2020.10.031. Epub 2020 Oct 23.
Despite the effectiveness of total knee arthroplasty (TKA), patients often have lingering pain and dysfunction. Recent studies have raised concerns that preoperative mental health may negatively affect outcomes after TKA. The primary aim of this study investigates the relationship between patient-reported mental health and postoperative physical function following TKA.
A retrospective study of 1392 primary TKA patients was performed. Mental health and physical function scores were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health, and PROMIS Physical Function 10a and Knee injury and Osteoarthritis Outcome Score Physical Function (KOOS-PS) short forms. These assessments were completed preoperatively and up to 1-year postoperatively. Patients were stratified based on preoperative mental health scores into five distinct categories ranging from "Poor" to "Excellent." Locally estimated scatter plot smoothing curves (LOESS) were fit to the data examining physical function score trends over time.
Patients with higher mental health scores before surgery demonstrated better preoperative and postoperative physical function scores. However, all patients experienced similar gains in physical function following surgery. Despite this early improvement, patients with the worst mental health scores experienced a sharp decline in physical function approximately a year after surgery and did not appear to recover.
Poor mental health should not be a contraindication for performing TKA. For patients with the lowest mental health scores, physicians should account for the possibility that physical function scores may deteriorate a year after surgery. Tighter follow-up guidelines, more frequent physical therapy visits, or treatment for mental health issues may be considered to counter such deterioration.
尽管全膝关节置换术（TKA）效果显著，但患者仍常伴有残留疼痛和功能障碍。最近的研究引起了人们的关注，即术前心理健康状况可能会对 TKA 后的结果产生负面影响。本研究的主要目的是调查 TKA 后患者报告的心理健康状况与术后身体功能之间的关系。
对 1392 例初次 TKA 患者进行了回顾性研究。使用患者报告结局测量信息系统（PROMIS）总体健康、PROMIS 身体功能 10a 和膝关节损伤和骨关节炎结局评分身体功能（KOOS-PS）简短形式来测量心理健康和身体功能评分。这些评估在术前和术后 1 年内完成。根据术前心理健康评分，患者分为五个不同类别，范围从“差”到“优”。使用局部估计散点图平滑曲线（LOESS）拟合数据，以检查随时间推移的身体功能评分趋势。
术前心理健康评分较高的患者表现出更好的术前和术后身体功能评分。然而，所有患者在手术后都经历了类似的身体功能改善。尽管有这种早期改善，但心理健康状况最差的患者在手术后大约一年经历了身体功能的急剧下降，且似乎没有恢复。
较差的心理健康状况不应成为进行 TKA 的禁忌症。对于心理健康评分最低的患者，医生应考虑到术后一年身体功能评分可能恶化的可能性。可能需要更严格的随访指南、更频繁的物理治疗就诊或治疗心理健康问题，以防止这种恶化。
