Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Psychological Predictors of Failure to Improve After Lower Extremity Joint Arthroplasty.
Brummett1, Chad M., Hallstrom1, Brian, Urquhart1, Andrew, Morris1, Michelle, Clauw2, Daniel J., Williams3, David A.
The lifetime risk for symptomatic knee osteoarthritis has been estimated at 45%, and the number of lower extremity arthroplasties conducted each year is anticipated to rise exponentially. The rate of failure to improve following arthroplasty is estimated to be between 2040% for knees and 10% for hips. We present preliminary results of an ongoing study investigating the phenotypic predictors of failure to improve after lower extremity joint arthroplasty.
Patients scheduled for total hip and knee arthroplasty (THA and TKA) were recruited in the immediate preoperative area. The anticipated recruitment for the study is 2000 lower extremity total joint arthroplasty patients over a 5-year period. Patients completed a preoperative phenotyping battery of validated self-report questionnaires, including the Brief Pain Inventory and Hospital Anxiety and Depression Scale. Patients were then contacted at 1- and 3-months after surgery by phone and at 6-months postoperatively by mail with the same measures, as appropriate. At each follow up, patients were asked to rate the success of their surgery using the Patient Global Impression of Change (PGIC). Data were analyzed using PASW Version 18. THA and TKA patients were grouped for analysis of predictors of outcome. For comparisons of outcomes at 6-months, patients were categorized using the PGIC as treatment "Success" (+2 or +3) or "Failure" ([-3][+1]) for comparisons of baseline characteristics. Between-group comparisons were made using the Mann-Whitney test. A Bonferroni correction for multiple comparisons was conducted (a= 0.0125).
To date, 337 arthroplasty patients have been recruited with a recruitment rate of 83%. Retention rates are 96%, 91%, and 77% at 1-, 3-, and 6-months respectively. At 6-months (n = 211), 16% of patients were classified as failed therapy using the PGIC (TKA = 24.3% vs THA = 9.3%, p = 0.011). There were no significant differences in baseline pain score between patients classified as failed versus success (median 4.75 [IQR 3, 6.75] vs 4.75 [3.25, 6.0], p = 0.555) Patients classified as failed therapy reported higher baseline scores for depression (median 6.5 [IQR 5, 8] vs. 4 [2, 6], p = 0.012) and anxiety (7 [5, 8] vs. 5 [3, 7], p = 0.091). Patients in the Success group showed a trend towards a more positive affect on the positive subscale of the HADS (3 [1, 5] vs. 4.5 [3, 7], p = 0.052).
Preliminary data indicate that higher levels of depression are associated with poor outcomes in lower extremity joint arthroplasty. Anxiety and low positive affect show trends towards poor outcome. Recruitment is ongoing, and future analyses of predictors of success and failure will be conducted.
To cite this abstract, please use the following information:
Brummett, Chad M., Hallstrom, Brian, Urquhart, Andrew, Morris, Michelle, Clauw, Daniel J., Williams, David A.; Psychological Predictors of Failure to Improve After Lower Extremity Joint Arthroplasty. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1988