OPTIMAL IMPROVEMENT IN FUNCTION AFTER TOTAL HIP AND KNEE REPLACEMENT: HOW DEEP DO YOU KNOW YOUR PATIENT’S MIND?

Area of Science:

• Orthopedics
• Psychology
• Rehabilitation Medicine

Background:

• Osteoarthritis (OA) of the hip and knee leads to pain and functional limitations, often necessitating total joint replacement when conservative treatments fail.
• Patients undergoing total hip replacement (THR) and total knee replacement (TKR) have high expectations for functional recovery, and unmet expectations can lead to dissatisfaction even after successful surgery.
• Emerging evidence suggests psychological factors play a role in the outcomes of THR and TKR.

Purpose of the Study:

• To prospectively investigate the influence of psychological factors and mental status on the outcomes of primary total hip and knee replacement.
• To identify pre-operative psychological and demographic variables that correlate with post-operative functional scores and patient satisfaction.

Main Methods:

• A prospective study of 280 patients with hip or knee OA undergoing total joint replacement.
• Pre-operative assessments included Harris Hip Score (HHS), Knee Society Score (KSS), SF-36, Mini-Mental Status Examination (MMSE), Symptom Checklist-90-R (SCL-90-R), BRIEF-COPE, and APAIS.
• Clinical and radiographic follow-up was conducted at 1, 3, and 6 months post-operatively.

Main Results:

• Pre-operative HHS and KSS scores correlated linearly with SCL-90-R and MMSE.
• No investigated pre-operative variables directly influenced post-operative HHS and KSS scores.
• Improvement in functional scores was significantly associated with SCL-90-R values, VAS score, schooling, and MMSE.

Conclusions:

• Psychological factors and mental status are significant determinants of outcome and patient satisfaction following primary total hip and knee replacement.
• Pre-operative identification and management of psychological conditions are essential for optimizing patient outcomes and satisfaction after total joint replacement.