Preoperative Resilience as a Predictor of Postoperative Regret and Patient-Reported Outcomes in Total Knee Arthroplasty.

Abstract

Background: Total knee arthroplasty (TKA) is a well-established treatment option for advanced knee osteoarthritis, yet some patients remain unsatisfied after surgery. Evaluation of various psychosocial parameters may improve patient optimization and outcomes. The primary aim was to assess whether preoperative resilience remained stable and influenced decision regret postoperatively while the secondary aim was to evaluate its correlation with joint-specific and global health patient-reported outcome measures.

Methods: A total of 1,269 patients undergoing elective unilateral TKA were included. Patients completed the Brief Resilience Scale preoperatively and postoperatively and were stratified into low, normal, and high resilience cohorts. Decision regret scale scores were obtained postoperatively, and patients were stratified into no regret, mild regret, and moderate/severe regret cohorts. Patients' knee pain and function were assessed using the Knee Osteoarthritis Outcome Score Joint Replacement survey. Physical and mental quality of life was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS-10).

Results: Preoperatively, 8% of patients were categorized as having low resilience, 67% had normal resilience, and 25% had high resilience. Resilience among each cohort remained relatively static. A statistically significant negative correlation between Brief Resilience Scale and decision regret scale scores was observed at 12-month follow-up (P < 0.001). The high resilience cohort demonstrated the lowest decision regret scale scores at all time points. The low resilience cohort reported higher decision regret scale scores at all time points but had the most improvement over the 12-month follow-up (P < 0.001). Knee Osteoarthritis Outcome Score Joint Replacement scores had a weak-to-low positive correlation with preoperative resilience (r = 0.29, P = 0.05). Preoperative resilience had a low positive correlation with PROMIS-10 Physical scores (r = 0.36, P < 0.05), but a moderately strong positive correlation with PROMIS-10 Mental scores (r = 0.47, P < 0.05).

Conclusion: Preoperative resilience can markedly influence decision regret after TKA. These findings are valuable because they can help surgeons appropriately counsel patients, leading to improved satisfaction after surgery.