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Anxiety Sets in Two Years After Knee Replacement

Psychosocial factors, such as support, depression, coping, and optimism are associated with pain, function, and satisfaction two years after total knee arthroplasty, shows a study from MD Anderson Cancer Center.

Psychosocial factors, such as tangible support, depression, dysfunctional coping, and optimism are associated with pain, function, and satisfaction two years after total knee arthroplasty, shows a study from MD Anderson Cancer Center.

The study, which was led by Maria A. Lopez Olivo, M.D., M.Sc., Ph.D., suggests that perioperative programs that focus on identifying and addressing psychosocial problems may lead to improvements in pain and function after the surgery.

Dr. Olivo’s objective was to evaluate the association of preoperative psychosocial and demographic factors that may influence how well osteoarthritis patients fare after knee surgery 24 months later.

The study, which included 178 patients, found that WOMAC pain scores at 24 months were associated with increasing age and a high body mass index. Other factors included the lack of social support, more stress and low optimism, which were correlated with more intense pain and worse function.

In general, older age, having a high BMI, the presence of comorbidities and depression were all associated with worse outcomes. Dr. Olivo suggests that patients be screened for factors like these that may affect outcomes. In this study, the level of anxiety patients experienced before the surgery, decreased after the surgery, but only to re-emerge two years later.

“In our analysis of six‐month outcomes, anxiety scores significantly decreased compared with baseline, which was a finding corroborated in another study. However, at 24‐months we observed a small increase in anxiety levels at 24 months, although the mean value remained within the normal range. Anxiety, not as a disorder but as an expression of worry, can increase in older adults. The mean age of our cohort was 63 at the time of surgery, and aging after two years could possibly have mildly increased anxiety levels, as the effect size although statistically significant was quite small. One could speculate that improvement in outcomes in the short-term could decrease anxiety, but after this initial impact, worrying and the associated anxiety could have increased after two years in these older adults. Another possible explanation of increased anxiety may be due in part to the patients’ awareness of the prosthesis. A prior qualitative study reported that some participants worry because their prosthesis feels foreign to their bodies and they fear that it could initiate an inflammatory response, induce a malignancy, or lead to more surgery,” Dr. Olivo and colleagues wrote in the study.

In this interview, Dr. Olivo reviews the findings.



Maria A. Lopez‐Olivo MD, PhD;Aparna Ingleshwar BDS, MPH;Glenn C. Landon MD; et al."Psychosocial Determinants of Total Knee Arthroplasty Outcomes Two Years After Surgery," ACR Open Rheumatology. Sept. 24, 2020.