Elsevier

The Journal of Arthroplasty

Volume 34, Issue 11, November 2019, Pages 2620-2623.e1
The Journal of Arthroplasty

Primary Arthroplasty
Impact of Resilience on Outcomes of Total Knee Arthroplasty

https://doi.org/10.1016/j.arth.2019.06.008Get rights and content

Abstract

Background

Resilience, defined as the ability to bounce back from stress, has been suggested as a predictor of surgical outcomes. The purpose of this study is to examine the relationship between resilience and patient-reported outcomes following primary elective total knee arthroplasty (TKA). We hypothesized that patients exhibiting greater preoperative resilience would report better outcome scores.

Methods

A prospective cohort of 153 patients (74 male, 79 female) undergoing primary elective TKA completed questionnaires preoperatively and at 3 and 12 months following their index procedure. The validated Brief Resilience Scale was used to evaluate resilience. Hierarchical multiple linear regression was used to analyze the effect of resilience on KOOS-JR (Knee Injury and Osteoarthritis Outcome Score JR) and PROMIS-10 (Patient-Reported Outcomes Measurement Information System) outcome scores.

Results

At 12 months, the change in the coefficient of determination (R2) attributable to preoperative resilience was 0.101 (P < .001) and 0.204 (P < .001) for physical and mental health, respectively. Although there was expected improvement in KOOS-JR scores following TKA, the effect of baseline resilience for this outcome was not significant. When evaluating resilience measured concurrently, there was significant correlation with both 3-month and 12-month KOOS-JR and PROMIS-10 outcome scores.

Conclusion

Preoperative resilience is a significant predictor of overall physical and mental health outcomes at both 3 and 12 months. Greater concurrent resilience predicted better scores across all outcomes. These findings suggest that major elective surgery, like other traumatic events, can cause a change in resilience. Although functional improvements after TKA are expected, those patients who exhibit greater resilience at baseline are more likely to report an improved quality of life.

Section snippets

Patient-Reported Outcome Measures

The Knee Injury and Osteoarthritis Outcome Score JR (KOOS-JR) was used to measure knee-specific health. The KOOS-JR is a 7-item holistic assessment of pain, symptom severity, and activities of daily living including movements or activities that are directly relevant and difficult for patients with advanced knee osteoarthritis [11]. It has been validated for short and long-term follow-up studies of knee injury and osteoarthritis [12], [13], [14].

The PROMIS-10 (Patient-Reported Outcomes

Demographic Characteristics

A prospective cohort of 242 patients (109 male, 133 female) were identified and consented for participation in the study. At the 3-month follow-up window, 69 patients were excluded (45 were lost to follow-up, and 24 either had a second knee surgery or had canceled their surgery). At the 12-month follow-up period, an additional 20 patients were excluded as all lost to follow-up after a minimum of 3 attempts to obtain survey data. The final analysis included a total of 153 patients (74 male, 79

Discussion

Resilience has been extensively studied in populations routinely exposed to intense psychological trauma or stress. Most common among these groups are soldiers and those suffering from post-traumatic stress disorder [20]. Although these populations are on the extreme end of the spectrum, many people will experience some level of emotional distress at some point in their life. For patients who are suffering from advanced knee osteoarthritis, feelings of emotional and/or physical distress can be

Conclusion

TKA is an extremely effective treatment option to reduce knee pain and improve knee function. Interestingly, we did not detect changes in PROMIS Mental outcomes which suggest that mental health status remains relatively consistent over the timeframe studied. Whether a patient pending TKA has been found to have a low or high level of resilience, they can expect to see marked improvements in their overall knee health. However, assessment of resilience before surgery can predict 12-month outcomes

Acknowledgments

The authors wish to thank the orthopedic surgeons contributing patients to this study: Jeffrey Burns, Mark Shekhman, Courtland Lewis, Gordon Zimmermann, Durgesh Nagarkatti, Paul Murray, Peter Barnett, Robert Carangelo, and Michael Miranda.

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    This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.06.008.

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