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The presence and influence of mild depressive symptoms on post-operative pain perception following primary total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the influence of mild depression on pain perception after total knee arthroplasty (TKA).

Methods

Hamilton depression (HDRS) and numeric rating (NRS) scales were used to evaluate depression severity and pain perception at various intervals surrounding TKA. The Hospital for Special Surgery (HSS) knee and pain scores (NRS) in patients with signs of mild depression (HDRS < 20 points) were compared to a control group of patients with no signs of depression (HDRS < 8 points).

Results

Prior to surgery, there were no statistical differences in pain perception (NRS) or individual components of HSS knee score including range of motion, pain, and function between patients with mild depression compared to controls. However, following surgery, patients with signs of mild depression were more likely to report more pain (p < 0.001) and have lower HSS scores even at 1 year post-operatively (p < 0.001).

Conclusions

A significant number of patients in this series undergoing routine primary TKA had signs of subclinical depression. These patients are more likely to report increased pain even at 1 year following surgery compared to patients without signs of depression preoperatively. Psychometric evaluation prior to surgery can help identify the at-risk patient and allow for proper management of patient expectations, thus improving clinical results and patients’ satisfaction after TKA.

Level of evidence

Prospective comparative study, II.

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References

  1. Ali A, Sundberg M, Robertsson O, Dahlberg LE, Thorstensson CA, Redlund-Johnell I et al (2014) Dissatisfied patients after total knee arthroplasty. Acta Orthop 85(3):229–233

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bagby RM, Ryder AG, Schuller DR, Marshall MB (2004) The Hamilton depression rating scale: has the gold standard become a lead weight? Am J Psychiatry 161(12):2163–2177

    Article  PubMed  Google Scholar 

  3. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P (2012) What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2:e000435

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bistolfi A, Lee GC, Deledda D, Rosso F, Berchialla P, Crova M, Massazza G (2014) NexGen® LPS mobile bearing total knee arthroplasty: 10-year results. Knee Surg Sports Traumatol Arthrosc 22(8):1786–1792

    Article  PubMed  Google Scholar 

  5. Bistolfi A, Massazza G, Rosso F, Deledda D, Gaito V, Lagalla F et al (2011) Cemented fixed-bearing PFC total knee arthroplasty: survival and failure analysis at 12–17 years. J Orthop Traumatol 12(3):131–136

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Blackburn J, Qureshi A, Amirfeyz R, Bannister G (2012) Does preoperative anxiety and depression predict satisfaction after total knee replacement? Knee 19(5):522–524

    Article  PubMed  Google Scholar 

  7. Bonnin MP, Basiglini L (2011) What are the factors of residual pain after uncomplicated TKA? Knee Surg Sports Traumatol Arthrosc 19:1411–1417

    Article  PubMed  Google Scholar 

  8. Bourne RB, Chesworth BM, Davis A, Mahomed N, Charron K (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63

    Article  PubMed  Google Scholar 

  9. Brander V, Gondek S, Martin E, Stulberg D (2007) Pain and depression influence outcome 5 years after knee replacement surgery. Clin Orthop Relat Res 464:21–26

    PubMed  Google Scholar 

  10. Buechel FF Sr (2002) Long-term follow up after mobile-bearing total knee replacement. Clin Orthop Relat Res 404:40–50

    Article  Google Scholar 

  11. Duivenvoorden T, Vissers MM, Verhaar JA, Busschbach JJ, Gosens T, Bloem RM et al (2013) Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study. Osteoarthritis Cartilage 21(12):1834–1840

    Article  CAS  PubMed  Google Scholar 

  12. Edwards RR, Hayhornthwaite JA, Smith MT, Klick B, Katz JN (2009) Catastrophizing and depressive symptoms as prospective predictors of outcomes following total knee replacement. Pain Res Manage 14:307–311

    Article  Google Scholar 

  13. Escobar A, Quintana JM, Bilbao A, Aróstegui I, Lafuente I, Vidaurreta I (2007) Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage 15:273–280

    Article  CAS  PubMed  Google Scholar 

  14. Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH (1990) Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol 17:1022–1024

    CAS  PubMed  Google Scholar 

  15. Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D et al (1999) Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum 42:1722–1728

    Article  CAS  PubMed  Google Scholar 

  16. Gerber PD, Barrett JE, Barrett JA, Oxman TE, Manheimer E, Smith R et al (1992) The relationship of presenting physical complaints to depressive symptoms in primary care patients. J Gen Intern Med 7(2):170–173

    Article  CAS  PubMed  Google Scholar 

  17. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23(1):56–62

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R et al (1998) Health-related quality of life after knee replacement. J Bone Joint Surg Am 80-A:163–173

    Article  Google Scholar 

  19. Hirschmann MT, Testa E, Amsler F, Friederich NF (2013) The unhappy total knee arthroplasty (TKA) patient: higher WOMAC and lower KSS in depressed patients prior and after TKA. Knee Surg Sports Traumatol Arthrosc 21(10):2405–2411

    Article  PubMed  Google Scholar 

  20. Khatib Y, Madan A, Naylor JM, Harris IA (2015) Do psychological factors predict poor outcome in patients undergoing TKA? A systematic review. Clin Orthop Relat Res. doi:10.1007/s11999-015-4234-9

    PubMed  PubMed Central  Google Scholar 

  21. Mont MA, Serna FK, Krackow KA, Hungerford DS (1996) Exploration of radiographically normal total knee replacements for unexplained pain. Clin Orthop Relat Res 331:216–220

    Article  Google Scholar 

  22. Murray DW, Frost SJ (1998) Pain in the assessment of total knee replacement. J Bone Joint Surg Br 80B:426–431

    Article  Google Scholar 

  23. Parsch D, Krüger M, Moser MT, Geiger F (2009) Follow-up of 11–16 years after modular fixed-bearing TKA. Int Orthop 33(2):431–435

    Article  CAS  PubMed  Google Scholar 

  24. Pérez-Prieto D, Gil-González S, Pelfort X, Leal-Blanquet J, Puig-Verdié L, Hinarejos P (2014) Influence of depression on total knee arthroplasty outcomes. J Arthroplasty 29(1):44–47

    Article  PubMed  Google Scholar 

  25. Pressman SD, Cohen S (2005) Does positive affect influence health? Psychol Bull 131(6):925–971

    Article  PubMed  Google Scholar 

  26. Riddle DL, Wade JB, Jiranek WA (2010) Major depression, generalized anxiety disorder and panic disorder in patient scheduled for knee arthroplasty. J Arthroplasty 25(4):581–588

    Article  PubMed  Google Scholar 

  27. Riddle DL, Wade JB, Jiranek WA, Kong X (2010) Preoperative pain catastrophizing predicts pain outcome after knee arthroplasty. Clin Orthop Relat Res 468:798–806

    Article  PubMed  Google Scholar 

  28. Singh JA, Lewallen DG (2014) Depression in primary TKA and higher medical comorbidities in revision TKA are associated with suboptimal subjective improvement in knee function. BMC Musculoskelet Disord 11(15):127

    Article  Google Scholar 

  29. Singh JA, Lewallen DG (2014) Patient level improvements in pain and activities of daily living after total knee arthroplasty. Rheumatology 53(2):313–320

    Article  PubMed  Google Scholar 

  30. Utrillas-Compaired A, De la Torre-Escuredo BJ, Tebar-Martínez AJ, Asúnsolo-Del Barco Á (2014) Does preoperative psychologic distress influence pain, function, and quality of life after TKA? Clin Orthop Relat Res 472(8):2457–2465

    PubMed  PubMed Central  Google Scholar 

  31. Vince KG (2003) Why knees fail. J Arthroplasty 18(3 Suppl 1):39–44

    Article  PubMed  Google Scholar 

  32. Wylde V, Dieppe P, Hewlett S, Learmonth ID (2007) Total knee replacement: is it an effective procedure for all? Knee 14:417–423

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. AO Città della Salute e della Scienza, Department of Orthopedics, Traumatology and Rehabilitative Medicine, CTO Hospital, Via Zuretti 29, 10126, Turin, Italy

    Alessandro Bistolfi, Eugenio Graziano & Giuseppe Massazza

  2. Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Pennsylvania Hospital, 1 Cupp Pavilion, 51 N 39th Street, Philadelphia, PA, 19104, USA

    Gwo Chin Lee

  3. School of Rehabilitative Medicine, University of the Studies of Turin, Via Zuretti 29, 10126, Turin, Italy

    Elisa Bettoni, Patrizia Milani & Giuseppe Massazza

  4. Department of clinical and biological sciences, Statistics, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy

    Paola Berchialla

  5. Orthopaedic Department, San Luigi Hospital of Orbassano, Regione Gonzole 10, 10043, Orbassano, TO, Italy

    Alessandro Aprato

Authors
  1. Alessandro Bistolfi
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  2. Elisa Bettoni
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  3. Alessandro Aprato
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  4. Patrizia Milani
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  6. Eugenio Graziano
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  7. Giuseppe Massazza
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  8. Gwo Chin Lee
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Correspondence to Alessandro Bistolfi.

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Bistolfi, A., Bettoni, E., Aprato, A. et al. The presence and influence of mild depressive symptoms on post-operative pain perception following primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25, 2792–2800 (2017). https://doi.org/10.1007/s00167-015-3737-y

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  • DOI: https://doi.org/10.1007/s00167-015-3737-y

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