Do symptoms of anxiety and/or depression and pain intensity before primary Total knee arthroplasty influence reason for revision? Results of an observational study from the Dutch arthroplasty register in 56,233 patients

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Do symptoms of anxiety and/or depression and pain intensity before primary Total knee arthroplasty influence reason for revision? Results of an observational study from the Dutch arthroplasty register in 56,233 patients. / Sorel, Juliette C.; Oosterhoff, Jacobien H. F.; Broekman, Birit F. P. et al.

In: General hospital psychiatry, Vol. 78, 01.09.2022, p. 42-49.

Research output: Contribution to journal › Article › Academic › peer-review

BibTeX

@article{4be65f702ca54f3ea2b9863a3bc3404e,

title = "Do symptoms of anxiety and/or depression and pain intensity before primary Total knee arthroplasty influence reason for revision? Results of an observational study from the Dutch arthroplasty register in 56,233 patients",

abstract = "Objective: Anxiety, depression and greater pain intensity before total knee arthroplasty (TKA) may increase the probability of revision surgery for remaining symptoms even without clear pathology or technical issues. We aimed to assess whether preoperative anxiety/depression and pain intensity are associated with revision TKA for less clear indications. Methods: Less clear indications for revision were defined after a Delphi process in which consensus was reached among 59 orthopaedic knee experts. We performed a cox regression analyses on primary TKA patients registered in the Dutch Arthroplasty Registry (LROI) who completed the EuroQol 5D 3 L (EQ5D-3 L) anxiety/depression score to examine associations between preoperative anxiety/depression and pain (Numeric Rating Scale (NRS)) with TKA revision for less clear reasons. These analyses were adjusted for age, BMI, sex, smoking, ASA score, EQ5D-3 L thermometer and OKS score. Results: In total, 25.9% patients of the 56,233 included patients reported moderate or severe symptoms of anxiety/depression on the EQ5D-3 L anxiety/depression score. Of those, 615 revisions (45.5%) were performed for less clear reasons for revision (patellar pain, malalignment, instability, progression of osteoarthritis or arthrofibrosis). Not EQ5D-3 L anxiety/depression score, but higher NRS pain at rest and EQ5D-3 L pain score were associated with revision for less clear reason (HR: 1.058, 95% CI 1.019–1.099 & HR: 1.241, 95% CI 1.044–1.476, respectively). Conclusion: Our findings suggest that pain intensity is a risk factor for TKA revision for a less clear reason. The finding that preoperative pain intensity was associated with reason for revision confirms a likely influence of subjective, personal factors on offer and acceptance of TKA revision. The association between anxiety/depression and reason for revision after TKA may also be found when including more specific outcome measures to assess anxiety/depression and we therefore hope to encourage further research on this topic with our study, ideally in a prospective setting.",

keywords = "Arthroplasty, Delphi method, Implants, Knee, Primary knee arthroplasty, Revision surgery",

author = "Sorel, {Juliette C.} and Oosterhoff, {Jacobien H. F.} and Broekman, {Birit F. P.} and Jaarsma, {Ruurd L.} and Doornberg, {Job N.} and IJpma, {Frank F. A.} and Jutte, {Paul C.} and Anneke Spekenbrink-Spooren and Gademan, {Maaike G. J.} and Poolman, {Rudolf W.}",

note = "Funding Information: The authors would like to acknowledge Professor David Ring for the academic discussion that led to this study. In addition, the authors also would like to acknowledge and thank the patients and staff contributing to the Dutch Arthroplasty Registry. The authors are thankful for granting access to this Registry by the Dutch Arthroplasty Registry. The authors would also like to thank the following members of the Dutch Knee society who responded to the questions of the Delphi method:, Henk van der Hoeven, Pieter van der Woude, Stefan F. de Boer, Simon N. van Laarhoven, Peter A. Nolte, Jore H. Willems, Annemieke P. van Noort, Simen T. Hokwerda, Danielle D. Langeloo, Koen C. Defoort Joris A. Jansen, Wiebe C. Verra, Johan van der Stok, Hugo C. van der Veen, Mathijs R. Krijnen, Frank-Christiaan B.M. Wagenaar, Roel F.M.R. Kersten, Tim A.E.J. Boymans, Remco J.A. van Wensen, Victor A. van de Graaf, Igor C.J.B. van den Brand, Jelle P. van der List, Remko J.A. Sonnega, Jon H.M. Goossen, Corne J.M. van Loon, Bas Weerts, Mark N. Klinkenbijl, Anton M.J. Burgers, Harald I.H. Lampe, Alexander F.Y. van Wulfften Palthe, Sander Spruijt, Derk A. van Kampen, Jeroen C. van Egmond, Gerian C. Huitema, Peter Z. Feczko, Hennie Verburg, Lucien C.M. Keijser, Sebastiaan van de Groes, Hans-Peter W. van Jonbergen, H. Charles Vogely, Vincent Eggerding, Daniel Hoornenborg, Jose Smulders, Olaf J.W. Verhoof, Roel J.H. Custers, Bart J. Robben, Ronald A.W. Verhagen, Karin E. de Kroon, Roel P.M. Hendrickx, Eduard L.A.R. Mutsaerts, Nienke van Egmond, Albert H. van Houten, Petra Heesterbeek, Bert Boonen, Bas L. Fransen, Arjan de Beus, Ren{\'e} A. van den Wijngaard, Rogier A.M. van Drumpt. The investigation has been performed at Leiden University Medical Centre, Leiden, the Netherlands. The research didn't receive grants from any funding agency in the public, commercial of not-for-profit sectors. This study was declared exempt by the Medical Research Ethics Committee Leiden Den Haag Delft as they were of opinion that the Medical Research Involving Human Subjects act (Dutch abbreviation: WMO) did not apply to this study. ClinicalTrials.gov Identifier: NCT05105646, Juliette C. Sorel: Conceptualization, Data curation, Formal analysis, Investigation, Methology, Software, Validation, Visualization, Writing - original draft. Jacobien H. F. Oosterhoff: Conceptualization, investigation, Methology, Conceptualization, Writing - original draft. Birit F. P. Broekman: Conceptualization, Supervision, Writing - review. Ruurd L. Jaarsma: Supervision, Writing - review. Job N. Doornberg: Conceptualization, Supervision, Writing - review. Frank F. A. IJpma: Supervision, Writing - review. Paul C. Jutte: Supervision, Writing - review. Anneke Spekenbrink-Spooren: Data curation, Writing - review. Maaike G.J. Gademan: Conceptualization, Formal analysis, Investigation, Methology, Supervision, Writing - review. Rudolf W. Poolman: Conceptualization, Investigation, Methology, Supervision, Writing - review. None. Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = sep,

day = "1",

doi = "10.1016/j.genhosppsych.2022.07.001",

language = "English",

volume = "78",

pages = "42--49",

journal = "General hospital psychiatry",

issn = "0163-8343",

publisher = "Elsevier Inc.",

}

RIS

TY - JOUR

T1 - Do symptoms of anxiety and/or depression and pain intensity before primary Total knee arthroplasty influence reason for revision? Results of an observational study from the Dutch arthroplasty register in 56,233 patients

AU - Sorel, Juliette C.

AU - Oosterhoff, Jacobien H. F.

AU - Broekman, Birit F. P.

AU - Jaarsma, Ruurd L.

AU - Doornberg, Job N.

AU - IJpma, Frank F. A.

AU - Jutte, Paul C.

AU - Spekenbrink-Spooren, Anneke

AU - Gademan, Maaike G. J.

AU - Poolman, Rudolf W.

N1 - Funding Information: The authors would like to acknowledge Professor David Ring for the academic discussion that led to this study. In addition, the authors also would like to acknowledge and thank the patients and staff contributing to the Dutch Arthroplasty Registry. The authors are thankful for granting access to this Registry by the Dutch Arthroplasty Registry. The authors would also like to thank the following members of the Dutch Knee society who responded to the questions of the Delphi method:, Henk van der Hoeven, Pieter van der Woude, Stefan F. de Boer, Simon N. van Laarhoven, Peter A. Nolte, Jore H. Willems, Annemieke P. van Noort, Simen T. Hokwerda, Danielle D. Langeloo, Koen C. Defoort Joris A. Jansen, Wiebe C. Verra, Johan van der Stok, Hugo C. van der Veen, Mathijs R. Krijnen, Frank-Christiaan B.M. Wagenaar, Roel F.M.R. Kersten, Tim A.E.J. Boymans, Remco J.A. van Wensen, Victor A. van de Graaf, Igor C.J.B. van den Brand, Jelle P. van der List, Remko J.A. Sonnega, Jon H.M. Goossen, Corne J.M. van Loon, Bas Weerts, Mark N. Klinkenbijl, Anton M.J. Burgers, Harald I.H. Lampe, Alexander F.Y. van Wulfften Palthe, Sander Spruijt, Derk A. van Kampen, Jeroen C. van Egmond, Gerian C. Huitema, Peter Z. Feczko, Hennie Verburg, Lucien C.M. Keijser, Sebastiaan van de Groes, Hans-Peter W. van Jonbergen, H. Charles Vogely, Vincent Eggerding, Daniel Hoornenborg, Jose Smulders, Olaf J.W. Verhoof, Roel J.H. Custers, Bart J. Robben, Ronald A.W. Verhagen, Karin E. de Kroon, Roel P.M. Hendrickx, Eduard L.A.R. Mutsaerts, Nienke van Egmond, Albert H. van Houten, Petra Heesterbeek, Bert Boonen, Bas L. Fransen, Arjan de Beus, René A. van den Wijngaard, Rogier A.M. van Drumpt. The investigation has been performed at Leiden University Medical Centre, Leiden, the Netherlands. The research didn't receive grants from any funding agency in the public, commercial of not-for-profit sectors. This study was declared exempt by the Medical Research Ethics Committee Leiden Den Haag Delft as they were of opinion that the Medical Research Involving Human Subjects act (Dutch abbreviation: WMO) did not apply to this study. ClinicalTrials.gov Identifier: NCT05105646, Juliette C. Sorel: Conceptualization, Data curation, Formal analysis, Investigation, Methology, Software, Validation, Visualization, Writing - original draft. Jacobien H. F. Oosterhoff: Conceptualization, investigation, Methology, Conceptualization, Writing - original draft. Birit F. P. Broekman: Conceptualization, Supervision, Writing - review. Ruurd L. Jaarsma: Supervision, Writing - review. Job N. Doornberg: Conceptualization, Supervision, Writing - review. Frank F. A. IJpma: Supervision, Writing - review. Paul C. Jutte: Supervision, Writing - review. Anneke Spekenbrink-Spooren: Data curation, Writing - review. Maaike G.J. Gademan: Conceptualization, Formal analysis, Investigation, Methology, Supervision, Writing - review. Rudolf W. Poolman: Conceptualization, Investigation, Methology, Supervision, Writing - review. None. Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Publisher Copyright: © 2022 The Authors

PY - 2022/9/1

Y1 - 2022/9/1

N2 - Objective: Anxiety, depression and greater pain intensity before total knee arthroplasty (TKA) may increase the probability of revision surgery for remaining symptoms even without clear pathology or technical issues. We aimed to assess whether preoperative anxiety/depression and pain intensity are associated with revision TKA for less clear indications. Methods: Less clear indications for revision were defined after a Delphi process in which consensus was reached among 59 orthopaedic knee experts. We performed a cox regression analyses on primary TKA patients registered in the Dutch Arthroplasty Registry (LROI) who completed the EuroQol 5D 3 L (EQ5D-3 L) anxiety/depression score to examine associations between preoperative anxiety/depression and pain (Numeric Rating Scale (NRS)) with TKA revision for less clear reasons. These analyses were adjusted for age, BMI, sex, smoking, ASA score, EQ5D-3 L thermometer and OKS score. Results: In total, 25.9% patients of the 56,233 included patients reported moderate or severe symptoms of anxiety/depression on the EQ5D-3 L anxiety/depression score. Of those, 615 revisions (45.5%) were performed for less clear reasons for revision (patellar pain, malalignment, instability, progression of osteoarthritis or arthrofibrosis). Not EQ5D-3 L anxiety/depression score, but higher NRS pain at rest and EQ5D-3 L pain score were associated with revision for less clear reason (HR: 1.058, 95% CI 1.019–1.099 & HR: 1.241, 95% CI 1.044–1.476, respectively). Conclusion: Our findings suggest that pain intensity is a risk factor for TKA revision for a less clear reason. The finding that preoperative pain intensity was associated with reason for revision confirms a likely influence of subjective, personal factors on offer and acceptance of TKA revision. The association between anxiety/depression and reason for revision after TKA may also be found when including more specific outcome measures to assess anxiety/depression and we therefore hope to encourage further research on this topic with our study, ideally in a prospective setting.

AB - Objective: Anxiety, depression and greater pain intensity before total knee arthroplasty (TKA) may increase the probability of revision surgery for remaining symptoms even without clear pathology or technical issues. We aimed to assess whether preoperative anxiety/depression and pain intensity are associated with revision TKA for less clear indications. Methods: Less clear indications for revision were defined after a Delphi process in which consensus was reached among 59 orthopaedic knee experts. We performed a cox regression analyses on primary TKA patients registered in the Dutch Arthroplasty Registry (LROI) who completed the EuroQol 5D 3 L (EQ5D-3 L) anxiety/depression score to examine associations between preoperative anxiety/depression and pain (Numeric Rating Scale (NRS)) with TKA revision for less clear reasons. These analyses were adjusted for age, BMI, sex, smoking, ASA score, EQ5D-3 L thermometer and OKS score. Results: In total, 25.9% patients of the 56,233 included patients reported moderate or severe symptoms of anxiety/depression on the EQ5D-3 L anxiety/depression score. Of those, 615 revisions (45.5%) were performed for less clear reasons for revision (patellar pain, malalignment, instability, progression of osteoarthritis or arthrofibrosis). Not EQ5D-3 L anxiety/depression score, but higher NRS pain at rest and EQ5D-3 L pain score were associated with revision for less clear reason (HR: 1.058, 95% CI 1.019–1.099 & HR: 1.241, 95% CI 1.044–1.476, respectively). Conclusion: Our findings suggest that pain intensity is a risk factor for TKA revision for a less clear reason. The finding that preoperative pain intensity was associated with reason for revision confirms a likely influence of subjective, personal factors on offer and acceptance of TKA revision. The association between anxiety/depression and reason for revision after TKA may also be found when including more specific outcome measures to assess anxiety/depression and we therefore hope to encourage further research on this topic with our study, ideally in a prospective setting.

KW - Arthroplasty

KW - Delphi method

KW - Implants

KW - Knee

KW - Primary knee arthroplasty

KW - Revision surgery

UR - http://www.scopus.com/inward/record.url?scp=85134645446&partnerID=8YFLogxK

U2 - 10.1016/j.genhosppsych.2022.07.001

DO - 10.1016/j.genhosppsych.2022.07.001

M3 - Article

C2 - 35853417

VL - 78

SP - 42

EP - 49

JO - General hospital psychiatry

JF - General hospital psychiatry

SN - 0163-8343

ER -

ID: 25215114

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