Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty

Sharifah Adla Alattas, Toby Smith, Maria Bhatti, Daniel Wilson-Nunn, Simon Donell

Research output: Contribution to journalArticlepeer-review

82 Citations (Scopus)
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Purpose: Around 10–30 % of patients are dissatisfied with the results of their total knee arthroplasty (TKA). This review aimed to identify and evaluate the predictors of outcome measured by the three domains of health-related quality of life (pain, stiffness and function). The focus was on pre-operative psychological factors as related to other patient-related variables.

Methods: A systematic search was performed using the following databases: MEDLINE, PubMed, AMED, CINAHL, PsychINFO, SciFinder, Scopus, EMBASE, Cochrane, Lilacs, Web of Science and ScienceDirect. The quality of identified studies was assessed using the Critical Appraisal Skills Programme Cohort checklist.

Results: Ten studies met the eligibility criteria. From these, nine patient-related predictors of outcome were identified (depression, anxiety, age at surgery, gender (being female), medical co-morbidities, BMI, level of education, pre-operative pain severity and pre-operative knee function). Greater anxiety, pre-operative pain and function were the most significant factors to predict a poorer outcome of a TKA. The results of depression, gender (female), medical co-morbidities, BMI and level of education were variable among the included studies. There was very little evidence to support older age at operation as a predictor of poorer outcome.

Conclusion: Patients experiencing high levels of pain before surgery should be informed of the chances of improvement by having a TKA. A validated psychological screening tool that separates depression and anxiety is recommended as part of the pre-operative assessment stage. Patients presenting with symptoms of depression and anxiety should be identified and consulted before a TKA.
Original languageEnglish
Pages (from-to)3403–3410
Number of pages8
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number11
Early online date12 Oct 2016
Publication statusPublished - Nov 2017


  • Total knee arthroplasty
  • Depression
  • Anxiety
  • Results
  • Outcome
  • Quality of Life

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