1. Outcome after Total Knee Arthroplasty in the Patients with Psychologic Disorder Nam-Hong Choi, M.D. Young-Eun Park, M.D. Knee & Shoulder service Department of Orthopedic Surgery, Eulji Medical Center, Seoul, Korea

2. Introduction Aging society TKA with degenerative arthritis Psychologic disorder

3. There are rare studies reporting clinical outcomes after total knee arthroplasty in the patients with psychologic disorder in KOREA. To evaluate how the psychologic disorder influence the clinical outcomes after total knee arthroplasty Purpose

4. Materials & Methods Duration : 2003. 1 ~ 2008. 5 Patients with TKA (Nexgen LPS, Zimmer, Warsaw, IN) : 248 cases 19 patients, 35 knees with psychologic disorder mean age : 68.8 years 46 patients, 81 knees without psychologic disorder mean age : 67.1 years Ⓡ

5. Postoperative evaluations Knee society knee score Knee society functional score ROM WOMAC score Materials & Methods

6. Results P= 0.003P= 0.009P= 0.003

7. Results WOMAC score Prognosis 0-14Excellent 15-28Good 29-38Fair >38Poor WOMAC score

8. Results WOMAC score WOMAC item With psychologic disorderWithout psychologic disorder P-Value Ascending stairs1.470.970.000 Descending stairs1.521.210.022 Going shopping1.840.780.009 Taking off socks1.470.470.011 Lying in bed0.680.260.029 Getting in of bath0.940.150.044 Sitting0.680.320.004

9. Results P= 0.401

10. Discussions There is no definite criteria to classify old age. In Korea, 노인복지법 : 65 세 이상 국민연금법 : 60 세 이상 Prevalence of the psychologic disorder is increasing in elderly person. 19.3% in 40~49 years 17.8% in 50~59 years 20.6% in 60~64 years Epidemiologic features of the depression in elderly person Increasing in prevalence Female > Male Expressed as a physical symptom

11. Discussions Factors that were significantly associated with a stiff or painful outcome female sex, higher body mass index, previous knee surgery, patients on disability, DM, pulmonary disease, and depression. Fisher DA, et al. J Arthroplasty, 2007 Pain-related fears of movement are predictors of post-surgical functional difficulties. This study highlightened the prognostic value of psychological variables in the prediction of post-surgical health outcomes. Psychological variables might be playing an important role as determinants of problematic health outcomes following TKA. Sullivan M, et al. Pain, 2009

12. Discussions Lack of depression prompted better functional outcome in TKA. In order to maximize rehabilitation benefit, patients with recent TKA intervention are screened for distress and depression at admission and that psychological symptoms are treated. Caracciolo B, et al. Arch Gerontology Geriatrics, 2005

13. Discussions Preoperative depression and anxiety were associated with heightened pain at 1 year. 12.5 % patients reported moderate to severe pain 1 year after surgery despite an absence of clinical or radiographic abnormalities. Brander VA, et al. Clin Orthop Relat Res, 2003 Preoperative pain and depression predicted lower Knee Society score mostly related to lower function scores. Depression drives long-term outcomes; the Knee Society score is influenced by psychologic variables. Brander VA, et al. Clin Orthop Relat Res, 2007

14. Conclusion This study showed that both the knee society knee score and functional score were lower for patients with psychologic disorder compared to patients with no psychologic disorder. Therefore, the patients with psychologic disorder should be provided of an explanation that results after TKA would be less than those of patients with no psychologic disorder.