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Pain catastrophizing immediately after surgery predicts postoperative patient satisfaction one year after total knee
Tomofumi Kinoshita1, Tatsuhiko Kutsuna1, Kunihiko Watamori2
1Department of Orthopaedic Surgery, Ehime University Graduate School of Medicine, Toon, Japan.
Aims:
Patient satisfaction after total knee arthroplasty (TKA) is a key measure of clinical outcome. While preoperative pain catastrophizing is known to affect postoperative results, the impact of early postoperative catastrophizing remains unclear. This study aimed to evaluate whether early postoperative pain catastrophizing is associated with PS one year after TKA.
Methods:
We evaluated 254 knees in 254 patients undergoing TKA, assessing the Pain Catastrophizing Scale (PCS) and visual analogue scale (VAS) one day before, as well as one, three, and seven days after TKA. The 2011 Knee Society Score (KSS) was assessed preoperatively and one year postoperatively. Based on PS scores in the KSS, patients were classified into satisfaction (PS > 20) and dissatisfaction (PS ≤ 20) groups. PCS and VAS scores were compared between groups using the Mann-Whitney U test. Spearman's rank correlation coefficient and multiple regression analysis were used to evaluate relationships among factors.
Results:
Mean PCS scores were 22.8 (SD 12.6), 21.9 (SD 12.2), 18.3 (SD 10.8), and 15.2 (SD 10.5) one day before, as well as one, three, and seven days after TKA, respectively. PCS scores seven days after TKA were negatively correlated with patient satisfaction one year after TKA (ρ = -0.32, p < 0.001). The dissatisfaction group had significantly higher PCS scores at all postoperative timepoints (p = 0.010, p < 0.001, and p < 0.001, respectively.). There were no significant differences in VAS scores between groups at any timepoint. Multiple regression analysis revealed that the PCS score seven days after TKA was significantly associated with PS (β = -0.321, p < 0.001). The cutoff PCS score seven days post-TKA for the dissatisfaction group was 12 (area under the curve: 0.653).
Conclusion:
Patients who were dissatisfied with TKA outcomes persistently exhibited high PCS scores immediately after surgery. Surgeons should consider not only preoperative PCS and VAS scores, but also postoperative PCS scores in order to enhance postoperative patient satisfaction following TKA.
