人工膝関節置換術前の精神医学的問題が術後の短期成績に及ぼす影響

抄録

Objective: While good objective outcomes have been reported after total knee arthroplasty (TKA), 20% of patients are dissatisfied with the procedure. Psychiatric problems have been the recent focus of such dissatisfaction. The Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP) was developed in Japan. The purpose of the study was to assess the influence of psychiatric problems on clinical outcomes following primary TKA in Japanese patients with knee osteoarthritis.

Methods: A total of 173 patients were recruited in this study. They had a psychiatric evaluation using BS-POP preoperatively, and postoperative clinical assessments at three and six months after TKA. Subjective outcomes were evaluated using disease-specific and patient-derived quality of life measures, the Japanese Knee Osteoarthritis Measure (JKOM), and degree of satisfaction. In addition, objective outcomes were evaluated using the Knee Society score (KSS), Timed Up and Go (TUG) test, and range of motion of the knee. These clinical outcomes were compared between TKA patients with and without psychiatric problems.

Results: JKOM, KSS, TUG, and flexion contracture were not significantly different between the patient groups. Although patients without psychiatric problems had significantly higher knee flexion angles at three and six months after TKA, they demonstrated lower satisfaction three months after the procedure.

Conclusion: Our data indicate that psychiatric problems do not influence clinical outcomes after primary TKA. Since dissatisfaction after TKA is a multifactorial problem, we should continue to focus on the relationship between psychiatric problems and clinical outcomes, as many reports have demonstrated a significant correlation.