Arthritis

Updated 29 June 2016

Knee replacement may go poorly for people who think life isn't fair

People who tend to blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after knee replacement surgery, according to a new study.

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This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.

"Pain is a complex phenomenon that is influenced by biological, social, and psychological factors," said lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.

"Studies conducted with patients who suffer from arthritis because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not," she told Reuters Health by email.

But those studies had been with victims of injuries, where externalizing blame is a bit easier than for degenerative conditions like osteoarthritis, she noted.

Read: Poorer patients less happy with knee replacements

How the study was conducted

For the new study, a group of 116 men and women with severe osteoarthritis, between ages 50 and 85 years old and scheduled for knee replacement surgery in Canada, first filled out questionnaires assessing perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.

They rated their agreement with statements like, "It all seems so unfair" and "I am suffering because of someone else's negligence."

With another clinical questionnaire the patients gauged their pain levels and physical functioning.

After the knee replacement surgeries, which were all deemed successful, the patients rated their pain and function again at a one-year checkup.

The more a patient agreed before surgery that life seems unfair and others are to blame for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.

The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.

Read: Risk of gaining weight with knee replacement

"A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery," said Dr. Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.

This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, told Reuters Health by email.

"All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time," Brander said.

"The contrary is also true - patients who exhibit high levels of 'self-efficacy' (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement," she said.

Osteoarthritis, the wearing away of cartilage, joint lining, ligaments and bone in a joint, affects one third of people over age 65 in the U.S., according to the Centres for Disease Control and prevention.

Knee replacement surgery can relieve pain and restore mobility, but about 20 percent of patients will have a problematic recovery or intense pain, based on previous research.

Read: Obesity causing increase in knee replacements 

How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it's hard to say if having a more negative outlook is common or uncommon, Yabokov said.

Researchers don't yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she said.

Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she said.

"This might suggest the usefulness of screening patients in terms of 'catastrophizing,' perceived injustice, fear of movement, and recovery expectancies before treatment or surgery," she said. "With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients' needs.

Read more:

Preventing knee pain 

Causes of knee pain 

Symptoms of knee pain 


 

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Professor Asgar Ali Kalla completed his MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 1975 at the University of Cape Town and his FRCP in 2003 in London. Professor Ali Kalla is the Isaac Albow Chair of Rheumatology at the University of Cape Town and also the Head of Division of Rheumatology at Groote Schuur Hospital. He has participated in a number of clinical trials for rheumatology and is active in community outreach. Prof Ali Kalla is an expert in Arthritis for Health24.

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