Impact of Resilience on Outcomes of Total Knee Arthroplasty

Robert J Magaldi; Ilene Staff; Ashly E Stovall; Sherry A Stohler; Courtland G Lewis

doi:10.1016/j.arth.2019.06.008

Impact of Resilience on Outcomes of Total Knee Arthroplasty

J Arthroplasty. 2019 Nov;34(11):2620-2623.e1. doi: 10.1016/j.arth.2019.06.008. Epub 2019 Jun 12.

Authors

Robert J Magaldi¹, Ilene Staff¹, Ashly E Stovall¹, Sherry A Stohler¹, Courtland G Lewis¹

Affiliation

¹ Department of Orthopedic Surgery, Bone and Joint Institute at Hartford Hospital, Hartford, CT.

PMID: 31278038
DOI: 10.1016/j.arth.2019.06.008

Abstract

Background: Resilience, defined as the ability to bounce back from stress, has been suggested as a predictor of surgical outcomes. The purpose of this study is to examine the relationship between resilience and patient-reported outcomes following primary elective total knee arthroplasty (TKA). We hypothesized that patients exhibiting greater preoperative resilience would report better outcome scores.

Methods: A prospective cohort of 153 patients (74 male, 79 female) undergoing primary elective TKA completed questionnaires preoperatively and at 3 and 12 months following their index procedure. The validated Brief Resilience Scale was used to evaluate resilience. Hierarchical multiple linear regression was used to analyze the effect of resilience on KOOS-JR (Knee Injury and Osteoarthritis Outcome Score JR) and PROMIS-10 (Patient-Reported Outcomes Measurement Information System) outcome scores.

Results: At 12 months, the change in the coefficient of determination (R²) attributable to preoperative resilience was 0.101 (P < .001) and 0.204 (P < .001) for physical and mental health, respectively. Although there was expected improvement in KOOS-JR scores following TKA, the effect of baseline resilience for this outcome was not significant. When evaluating resilience measured concurrently, there was significant correlation with both 3-month and 12-month KOOS-JR and PROMIS-10 outcome scores.

Conclusion: Preoperative resilience is a significant predictor of overall physical and mental health outcomes at both 3 and 12 months. Greater concurrent resilience predicted better scores across all outcomes. These findings suggest that major elective surgery, like other traumatic events, can cause a change in resilience. Although functional improvements after TKA are expected, those patients who exhibit greater resilience at baseline are more likely to report an improved quality of life.

Keywords: outcomes; patient-reported outcomes; positive psychology; resilience; total knee arthroplasty.

MeSH terms

Arthroplasty, Replacement, Knee*
Female
Humans
Male
Osteoarthritis, Knee* / surgery
Patient Reported Outcome Measures
Prospective Studies
Quality of Life
Surveys and Questionnaires
Treatment Outcome