Postoperative Outcomes Following Total Hip and Knee Arthropl
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The relationship between pain catastrophizing, emotional disorders and total joint arthroplasty (TJA) outcomes is an emerging area of study. The purpose of this study was to examine the association of these factors with one-year postoperative pain and functional outcomes. A prospective cohort study of preoperative TJA patients using the Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scale (HADS-A/HADS-D) was conducted.

Postoperative outcomes included visual analogue pain scale (VAS), Oxford, Harris Hip (HHS) and Knee Society (KSS) scores. Median regression was used to assess the pattern of relationship between preoperative clinically relevant pain catastrophizing (CRC), abnormal HADS and one-year postoperative outcomes.

--463 TJA patients were recruited , all of which completed one-year follow-up.

--At one-year, CRC-rumination (adjusted median difference 1) abnormal HADS-A (adjusted median difference 1) were predictors of VAS pain, CRC-magnification, a predictor of HHS/KSS (adjusted median difference 1.3), and abnormal HADS-A a predictor of Oxford (adjusted median difference 3.68).

--CRC patients demonstrated inferior VAS pain, Oxford and HHS/KSS.

--Abnormal HADS patients demonstrated inferior postoperative VAS (HADS-A, HADS-D) and Oxford (HADS-A, HADS-D).

--However, patients with CRC experienced significant improvement in VAS, Oxford and HHS/KSS from preoperative to one-year.

--Similarly, patients with abnormal HADS showed significant improvement in VAS pain and HHS/KSS.

In particular, there is inferior preoperative and postoperative pain and function in TJA patients who are nervous, depressed or pain catastrophic. However, after hip/knee arthroplasty, clinically meaningful change can be expected in relation to their preoperative status.