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Psychosocial determinants of outcomes in knee replacement
  1. Maria A Lopez-Olivo1,
  2. Glenn C Landon2,
  3. Sherwin J Siff2,
  4. David Edelstein2,
  5. Chong Pak1,
  6. Michael A Kallen1,
  7. Melinda Stanley3,4,5,
  8. Hong Zhang1,
  9. Kausha C Robinson1,
  10. Maria E Suarez-Almazor1
  1. 1The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
  2. 2St Luke's Episcopal Health System, Houston, Texas, USA
  3. 3Houston VA HSR&D Center of Excellence, Health Services Research and Development Service, Department of Veteran Affairs Medical Center, Houston, Texas, USA
  4. 4Baylor College of Medicine, Houston, Texas, USA
  5. 5VA South Central Mental Illness Research, Education and Clinical Center, North Little Rock, Arkansas, USA
  1. Correspondence to Dr Maria E Suarez-Almazor, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1467, Houston, TX 77030, USA; msalmazor{at}


Objective To identify potential psychosocial and educational barriers to clinical success following knee replacement.

Patients and Methods The authors evaluated 241 patients undergoing total knee replacement, preoperatively and 6 months after surgery. Outcomes included the Western Ontario McMaster (WOMAC) scale and the Knee Society rating system (KSRS). Independent variables included: the medical outcome study–social support scale; depression, anxiety and stress scale; brief COPE inventory; health locus of control; arthritis self-efficacy scale and the life orientation test–revised. Multiple regression models evaluated associations of baseline demographic and psychosocial variables with outcomes at 6 months, controlling for body mass index, comorbidities and baseline outcome scores.

Results Patients' mean age was 65±9 years; 65% were women. Most patients improved outcomes after surgery. Several psychosocial variables were associated with outcomes. Regression analyses indicated lower education, less tangible support, depression, less problem-solving coping, more dysfunctional coping, lower internal locus of control were associated with worse WOMAC scores (R2 contribution of psychosocial variables for pain 0.07; for function, 0.14). Older age, lower education, depression and less problem-solving coping were associated with poorer total KSRS scores (R2 contribution of psychosocial variables to total KSRS model 0.09). Psychosocial variables as a set contributed from 25% to 74% of total explained variance across the models tested.

Conclusion Patients' level of education, tangible support, depression, problem-solving coping, dysfunctional coping and internal locus of control were associated with pain and functional outcomes after knee replacement. The findings suggest that, in addition to medical management, perioperative psychosocial evaluation and intervention are crucial in enhancing knee replacement outcomes.

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  • Funding This study was supported by a grant from the National Institute for Arthritis, Musculoskeletal and Skin Disorders (NIAMS; R01 AR48662). MES-A is the recipient of a K24 career award from the National Institute for Musculoskeletal and Skin Disorders. She is also the Director of the Houston Center for Education and Research on Therapeutics, funded by the Agency for Healthcare Research and Quality. It was also partly supported by the VA HSR&D Houston Center of Excellence (HFP-90-020). The views expressed are those of the authors and do not necessarily reflect those of the Department of Veterans Affairs/Baylor College of Medicine. MES-A has received honoraria from Zimmer as a speaker at the 2010 Summit on Musculoskeletal Health Disparities.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Institutional Review Board of the University of Texas, MD Anderson Cancer Center, St Luke's Episcopal Health System and Baylor College of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.