Impact Of Psychological Factors On Postoperative Pain And Quality Of Life After Total Knee Arthroplasty

Background Chronic pain and dysfunction affect the emotional,cognitive and physiological functions of patients with knee osteoarthritis(KOA),KOA patients suffer from limited social activities and communication,poor medical outcomes,which increased risk of depression,anxiety,self reproach and other psychological disorders.With the improvement of artificial joint materials,continuous consummation of prosthesis design and the maturity of total knee arthroplasty(TKA),excellent effects has been achieved in treatment of KOA.However,a part of TKA patients with successful surgery,the adverse X-ray examination showed no loosening or undesirable axial alignment of the lower extremity,there are still often complain of pain or joint function can not meet the needs of daily life.In China,due to the restriction of the development of humanistic medicine,most clinicians and expert in China pay little attention to the influence of psychological factors on the disease.Objective To observe the effect of preoperative psychological disorders on postoperative pain and quality of life in patients with osteoarthritis who underwent unilateral total knee arthroplasty.Method 101 Patients with KOA who underwent unilateral total knee arthroplasty from the First Affiliated Hospital of Xinxiang Medical University between 2015 and 2016 were screened retrospectively.9 patients were excluded from the follow-up.The patients agreed to participate in this study and signed the informed consent.Firstly,Used the Hospital Anxiety and Depression Scale(HADS)to evaluate the preoperative psychological status of patients.Then used the Visual Analogue Scale(VAS)to assess the psychological status of the patients preoperative and postoperative 7 days,postoperative 1 months and postoperative 6 months.Used the American Knee Society score(KSS)to assess the situation of the patients who before operation,1 months after operation,and 6 months after the operation.The quality of life of the patients before and 6 months after operation was evaluated by the 36-item short form health survey(SF-36).At the same time,the patient's age,medical history,left behind,body mass index(BMI),preoperative erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were recorded.Result 1.After the assessment,there are 22 cases of patients with HADS more than 9 points,5 male and 17 female are included in the psychological group.This study have 49 cases of left-behind elderly,and 22 patients' s HADS more than 9 points.2.In the mental group,preoperative and postoperative 7 days,postoperative 1 months and postoperative 6 months used the VAS scores were no statistic difference between two groups(P>0.05).However,postoperative 7 days,postoperative 1 months and postoperative 6 months both two groups was statistically significant(P <0.05)for VAS.3.There was no significant difference in preoperative KSS score between the two groups(P >0.05),but postoperative 3 months and postoperative 6 months two groups was statistically significant(P <0.05)for KSS.4.Compared with the preoperative SF-36 score of the psychological group and control group,there was no significant difference in the physiological function,body pain,general health and vitality(P>0.05).But preoperative physiological function,social function,emotional function,mental health was statistically significant(P <0.05).Compared with the postoperative SF-36 score of two groups,there was significant difference in the 8 dimensions of physical health and mental health(P<0.05).5.In this study,53%(49/92)of the patients were left-behind elderly.Compared with the psychological group(n=20)and control group(n=29),there was significant difference in the the postoperative VAS score and the KSS knee and knee function score(P<0.05).Conclusion 1.If patients especially in the left behind elderly patients with anxiety and depression before operation,it means there were poor pain and function after surgery,.2.The patient's mental disorders will influence the knee function and quality of life.The improvement of postoperative pain symptoms could not reach the expected value,we should use psychological guidance or medication in clinical work.