Osteoarthritis
Psychological Factors Affecting the Outcome of Total Hip and Knee Arthroplasty: A Systematic Review

https://doi.org/10.1016/j.semarthrit.2011.07.003Get rights and content

Objectives

Recently, numerous studies have reported that psychological factors can influence the outcome of total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, a systematic overview is missing. The objective of this study was to examine which psychological factors influence the outcome of TKA and THA and to what extent.

Methods

Data were obtained from the MEDLINE and EMBASE databases from inception to January 2011. Search terms included TKA and THA, outcome measures, and psychological aspects. Two reviewers independently selected the studies. Studies with a prospective before–after design with a minimum follow-up time of 6 weeks were included. One reviewer extracted the results and 2 reviewers independently conducted quality assessment. We distinguished between follow-up shorter and equal or longer than 1 year.

Results

Thirty-five of 1837 studies met the inclusion criteria and were included in this systematic review. In follow-ups shorter than 1 year, and for knee patients only, strong evidence was found that patients with pain catastrophizing reported more pain postoperatively. Furthermore, strong evidence was found that preoperative depression had no influence on postoperative functioning. In long-term follow-up, 1 year after TKA, strong evidence was found that lower preoperative mental health (measures with the SF-12 or SF-36) was associated with lower scores on function and pain. For THA, only limited, conflicting, or no evidence was found.

Conclusions

Low preoperative mental health and pain catastrophizing have an influence on outcome after TKA. With regard to the influence of other psychological factors and for hip patients, only limited, conflicting, or no evidence was found.

Section snippets

Data Sources and Searches

A search for relevant studies was performed in MEDLINE and EMBASE since their inception up to January 2011. Search terms included total hip and knee arthroplasty, different outcome measures (pain, functioning, patient satisfaction, quality of life, mortality, and revision), and different psychological symptoms (patient expectations, depression, anxiety, mental health, physiological stress, self-efficacy, coping, vitality, and emotion). The full electronic search strategy for the MEDLINE

Identification and Selection of the Literature

The search resulted in 1837 articles, whose abstracts were reviewed. Through screening of the abstracts, 82 were identified as possibly relevant for which full articles were retrieved. After review of the full articles, 35 articles met all the inclusion criteria (Fig. 1). The reasons for excluding articles were as follows: not a prospective study with a before–after design and a minimum follow-up of 6 weeks (n = 13); evaluated none of the predefined outcome measures or determinants (n = 15); no

Discussion

In this systematic review we summarized the available evidence about the influence of psychological factors on the outcome after TKA and THA. We found that low preoperative mental health and pain catastrophizing have an influence on outcome. Different results were found for TKA and THA combined and separately. Therefore, the question arises whether we can combine the results of TKA and THA. From the results of this study it is not clear whether the differences are actually different between

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    The authors have no conflicts of interest to disclose.

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