Pain and depression influence outcome 5 years after knee replacement surgery
Pain and depression influence outcome 5 years after knee replacement surgery
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DOI：
10.1097/blo.0b013e318126c032
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发表时间：
2007-11-01
影响因子：
4.2
通讯作者：
Stulberg, S. David
中科院分区：
文献类型：
--
作者：
Brander, Victoria;Gondek, Stephen;Stulberg, S. David
我们之前报道过术前抑郁、焦虑和疼痛与全膝关节置换术后1年更大的疼痛、更多的医疗资源利用和更差的结果相关。我们询问这些结果是否会随着时间的推移而持续，以及术后早期不明原因的疼痛加剧患者是否最终满意。我们对83例患者（109例tka）术后5年进行前瞻性随访和评估。平均年龄66岁；55%是女性。术前疼痛和抑郁预测较低的膝关节社会评分主要与较低的功能评分相关。虽然在手术后的第一年，焦虑与更大的疼痛、更差的功能和更多的资源使用有关，但焦虑并不影响最终结果。大多数患者需要整整一年才能从手术中恢复，但术后大多数参数的改善微不足道。然而，在1年内出现不明原因疼痛加重的患者，疼痛在几年内逐渐改善。5年后，几乎所有患者都满意了。因此，假设良好的活动范围和对齐良好的植入物，大多数术后1年疼痛的患者可以放心，疼痛最终会改善。抑郁会带来长期结果；膝关节协会的评分受到心理变量的影响，并不仅仅反映与膝关节有关的问题。应考虑扩大这一工具，使其包括对心理和其他健康因素敏感的措施。
We previously reported preoperative depression, anxiety, and pain were associated with greater pain, more utilization of healthcare resources, and worse outcome 1 year after total knee arthroplasty. We asked whether these outcomes persisted over time and whether patients with unexplained heightened pain early after surgery were ultimately satisfied. We prospectively followed and evaluated 83 patients (109 TKAs) 5 years postoperative. The mean age was 66 years; 55% were women. Preoperative pain and depression predicted lower Knee Society score mostly related to lower function subscores. Although anxiety was associated with greater pain, worse function, and more use of resources in the first year after surgery, anxiety did not affect ultimate outcome. Most patients required a full year to recover from surgery but with negligible improvements in most parameters afterward. However, patients with heightened, unexplained pain at I year had progressive improvement in pain over several years. By 5 years, nearly all of these patients were satisfied. Therefore, assuming good range of motion and well-aligned implants, most patients with pain 1 year after surgery can be reassured pain ultimately improves. Depression drives long-term outcomes; the Knee Society score is influenced by psychologic variables and does not solely reflect issues related to the knee. Expansion of this tool to include measures sensitive to psychologic and other health factors should be considered.