Multiple Joint Involvement in Total Knee Replacement for Osteoarthritis-Effects on Patient Reported Outcomes

Objective: To determine whether symptomatic (painful/problematic) joints pre total knee replacement surgery (TKR), 1) influence pre and 12-month post-TKR patient-reported outcomes (pain, physical function, mood (fatigue, anxiety, and depression)); and 2) influence post-surgical pain and function mediated through mood. Methods: 494 participants completed the identified patient-reported outcome measures pre- and 12-months post-TKR. Symptomatic (painful/problematic) joints were indicated on a homunculus pre-surgery. Covariate data included age, sex, educational attainment, BMI and comorbidity. Pre- and post-surgical outcome scores were regressed on symptomatic joint sites and covariates using linear regression analyses; post-surgical scores additionally were regressed on pre-surgery scores. Path analyses examined whether the effects of symptomatic joint sites on post-surgical pain and function were mediated through mood. Results: Age range: 35-88 years (mean=65) with 65% female. Forty-six percent reported ≥4 symptomatic joints (other than surgical knee). Pre- and post-surgery, worse outcome scores were observed with increasing joint count. Adjusted for covariates, individuals reporting ankle/feet/toes, neck and spine/lower-back had worse pre-surgery fatigue and anxiety. Adjusted for covariates and pre-surgery status, worse fatigue for neck and spine/lower back, and worse depression, pain and function for ankle/feet/toes and neck were observed post-surgery. The influence of ankle/feet/toes on post-surgical pain and function was in part direct and partially mediated through depression. Full mediation was found for neck through fatigue, anxiety and depression and for spine/lower back through fatigue. Conclusions: Findings suggest a comprehensive approach to OA management/care are warranted, and identify important associations between symptomatic joints and mood which negatively impact post-TKR pain and physical function.Canadian Institutes of Health Researc