Outcome after Total Knee Arthroplastyin the Patients with Psychologic Disorder

Nam-Hong Choi, M.D.

Young-Eun Park, M.D.

Knee & Shoulder service

Department of Orthopedic Surgery,

Eulji Medical Center, Seoul, Korea

Introduction

Aging society

TKA with degenerative arthritis Psychologic disorder

• There are rare studies reporting clinical outcomes after total knee arthroplasty in the patients with psychologic disorder in KOREA.

• To evaluate how the psychologic disorder influence the clinical outcomes after total knee arthroplasty

Purpose

Materials & Methods

• Duration : 2003. 1 ~ 2008. 5

• Patients with TKA (Nexgen LPS, Zimmer, Warsaw, IN) : 248 cases

• 19 patients, 35 knees with psychologic disorder

mean age : 68.8 years

• 46 patients, 81 knees without psychologic disorder

mean age : 67.1 years

Ⓡ

• Postoperative evaluations

Knee society knee score

Knee society functional score

ROM

WOMAC score

Materials & Methods

Results

P= 0.003 P= 0.009 P= 0.003

Results

WOMAC score

Prognosis

0-14 Excellent

15-28 Good

29-38 Fair

>38 Poor

WOMAC score

Results

WOMAC score

WOMAC itemWith psychologic disorder Without psychologic disorder P-Value

Ascending stairs 1.47 0.97 0.000

Descending stairs 1.52 1.21 0.022

Going shopping 1.84 0.78 0.009

Taking off socks 1.47 0.47 0.011

Lying in bed 0.68 0.26 0.029

Getting in of bath 0.94 0.15 0.044

Sitting 0.68 0.32 0.004

Results

P= 0.401

Discussions

• There is no definite criteria to classify old age.

• In Korea,

노인복지법 : 65 세 이상 국민연금법 : 60 세 이상

• Prevalence of the psychologic disorder is increasing in elderly person.

19.3% in 40~49 years17.8% in 50~59 years20.6% in 60~64 years

• Epidemiologic features of the depression in elderly person

Increasing in prevalence Female > Male Expressed as a physical symptom

Discussions

• Factors that were significantly associated with a stiff or painful outcome

female sex, higher body mass index, previous knee surgery, patients on

disability, DM, pulmonary disease, and depression.

Fisher DA, et al. J Arthroplasty, 2007

• Pain-related fears of movement are predictors of post-surgical functional

difficulties.

• This study highlightened the prognostic value of psychological variables

in the prediction of post-surgical health outcomes.

• Psychological variables might be playing an important role as determinants of

problematic health outcomes following TKA.

Sullivan M, et al. Pain, 2009

Discussions

• Lack of depression prompted better functional outcome in TKA.

• In order to maximize rehabilitation benefit, patients with recent TKA

intervention are screened for distress and depression at admission

and that psychological symptoms are treated.

Caracciolo B, et al. Arch Gerontology Geriatrics, 2005

Discussions

• Preoperative depression and anxiety were associated with heightened pain

at 1 year.

• 12.5 % patients reported moderate to severe pain 1 year after surgery

despite an absence of clinical or radiographic abnormalities.

Brander VA, et al. Clin Orthop Relat Res, 2003

• Preoperative pain and depression predicted lower Knee Society score mostly

related to lower function scores.

• Depression drives long-term outcomes; the Knee Society score is influenced

by psychologic variables.Brander VA, et al. Clin Orthop Relat Res, 2007

Conclusion

• This study showed that both the knee society knee score and functional

score were lower for patients with psychologic disorder compared to

patients with no psychologic disorder.

• Therefore, the patients with psychologic disorder should be provided of an

explanation that results after TKA would be less than those of patients with

no psychologic disorder.