The Impact of Psychological Factors and Their Treatment on the Results of Total Knee Arthroplasty

被引:44
作者
Kazarian, Gregory S. [1 ,2 ]
Anthony, Christopher A. [2 ,3 ]
Lawrie, Charles M. [2 ]
Barrack, Robert L. [2 ]
机构
[1] Hosp Special Surg, Dept Orthopaed Surg, New York, NY USA
[2] Washington Univ, Barnes Jewish Hosp, Dept Orthopaed Surg, Sch Med, St Louis, MO 63130 USA
[3] Univ Penn, Dept Orthopaed Surg, Philadelphia, PA USA
关键词
CHRONIC POSTOPERATIVE PAIN; QUALITY-OF-LIFE; CUTANEOUS MECHANORECEPTIVE FIELDS; CHRONIC MUSCULOSKELETAL PAIN; DORSAL-HORN NEURONS; CENTRAL SENSITIZATION; OSTEOARTHRITIS PATIENTS; CONTROLLED-TRIAL; PATIENT SATISFACTION; PSYCHOSOCIAL FACTORS;
D O I
10.2106/JBJS.20.01479
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
There is a growing body of evidence implicating psychosocial factors, including anxiety, depression, kinesiophobia, central sensitization, and pain catastrophizing, as negative prognostic factors following total knee arthroplasty (TKA). Symptoms of anxiety and depression likely represent risk factors for negative outcomes in patients undergoing TKA. However, few studies have assessed the impact of preoperative interventions for these conditions on postoperative outcomes. The Tampa Scale of Kinesiophobia and the Central Sensitization Inventory have demonstrated value in the diagnosis of kinesiophobia and central sensitization. Higher preoperative indices of kinesiophobia and central sensitization predict worse patient-reported outcomes postoperatively. Although evidence is limited, cognitive-behavioral therapy for kinesiophobia and duloxetine for central sensitization may help to diminish the negative impact of these preoperative comorbidities. It is important to note, however, that outside the realm of TKA, cognitive-behavioral therapy has been recognized as a more effective treatment for central sensitization than medical treatment. Awareness of these issues will allow surgeons to better prepare patients regarding postoperative expectations in the setting of a comorbid psychosocial risk factor. Further research into the role of preoperative assessment and possible treatment of these conditions in patients undergoing TKA is warranted.
引用
收藏
页码:1744 / 1756
页数:13
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