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Preoperative psychosocial risk factors for poor outcomes at 1 and 5 years after total knee replacement: A cohort study of 266 patients

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)530-536
Number of pages7
JournalActa Orthopaedica
Issue number5
Early online date31 May 2017
DateAccepted/In press - 21 Apr 2017
DateE-pub ahead of print - 31 May 2017
DatePublished (current) - 3 Sep 2017


Background and purpose — Psychosocial factors are important risk factors for poor outcomes in the first year after total knee replacement (TKR), however their impact on long-term outcomes is unclear. We aimed to identify preoperative psychosocial risk factors for poor outcomes at 1 year and 5 years after TKR.

Patients and methods — 266 patients were recruited prior to TKR surgery. Knee pain and function were assessed preoperatively and at 1 and 5 years postoperative using the WOMAC Pain score, WOMAC Function score and American Knee Society Score (AKSS) Knee score. Preoperative depression, anxiety, catastrophizing, pain self-efficacy and social support were assessed. Statistical analyses involved multiple linear regression and mixed effect linear regression.

Results — Higher anxiety was a risk factor for worse pain at 1 year postoperative. No psychosocial factors were associated with any outcomes at 5 years postoperative. Analysis of change over time found that patients with higher pain self-efficacy had lower preoperative pain and experienced less improvement in pain up to 1 year postoperative. Higher pain self-efficacy was associated with less improvement in the AKSS up to 1 year postoperative but more improvement between 1 and 5 years postoperative.

Interpretation — Preoperative anxiety was found to influence pain at 1 year after TKR. However, none of the psychosocial variables were risk factors for a poor outcome at 5 years post­operative, suggesting that the negative effects of anxiety on outcome do not persist in the longer-term.

    Structured keywords

  • Centre for Surgical Research

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