Optimism and pessimism are antithetically associated with post-operative knee function in patients’ undergoing total knee arthroplasty

By
Felix Wunderlich
Jasmin Ghaemi Kerahrodi
Robert Kuchen
Thomas Klonschinski
Yama Afghanyar
Erik Wegner
Philipp Drees
Lukas Eckhard
May 5, 2023
0 min

Knee Surgery, Sports Traumatology, Arthroscopy

Overview

This study investigated the impact of dispositional optimism and pessimism on self-reported knee function following total knee arthroplasty (TKA). Results demonstrated that optimistic patients reported better post-operative knee function over the first year compared to pessimistic patients, highlighting the role of psychological factors in surgical outcomes.

Background

Total knee arthroplasty is effective for relieving pain and improving mobility in end-stage osteoarthritis, yet up to 30% of patients remain dissatisfied post-operatively. While mechanical causes of dissatisfaction are well studied, psychosocial factors such as personality traits have been less explored. Dispositional optimism and pessimism represent generalized expectations of favorable or unfavorable outcomes, which may influence patient effort and recovery. Prior research showed optimism benefits outcomes in hip arthroplasty, but its effect on TKA had not been studied.

Data Highlights

Characteristic	Value
Number of patients enrolled	933
Patients with complete data at 12 months	740
Measurement tool for optimism/pessimism	Revised Life Orientation Test (LOT-R)
Functional outcome measure	KOOS-12 (0-100 scale)
Minimum clinically important difference (MCID) for KOOS-12	11.1 points

Key Findings

Optimistic patients, as measured by the LOT-R, showed significantly better self-reported knee function post-TKA at 3, 6, and 12 months compared to pessimistic patients.
The LOT-R separates optimism and pessimism into distinct subscales, allowing nuanced assessment of personality traits.
Higher optimism scores correlated with higher KOOS-12 scores, indicating less pain and better function and quality of life.
Pessimism was associated with poorer functional outcomes despite no mechanical complications.
The study controlled for demographic and clinical variables, strengthening the association between optimism/pessimism and outcomes.

Clinical Implications

Assessment of dispositional optimism and pessimism pre-operatively may help identify patients at risk for poorer functional recovery after TKA. Incorporating psychological support or interventions to enhance optimism could improve patient satisfaction and outcomes. Surgeons should consider psychosocial factors alongside mechanical assessments when planning and managing TKA patients.

Conclusion

Dispositional optimism positively influences post-operative knee function following total knee arthroplasty, while pessimism is linked to worse outcomes. Recognizing and addressing these psychological factors may enhance recovery and patient satisfaction.

References

Balck et al. 2021 -- Positive influence of dispositional optimism on post-operative function in total hip arthroplasty
Scheier and Carver 1985 -- Model of dispositional optimism/pessimism
PROMISE Trial Study Protocol 2018 -- Multicenter prospective study on TKA outcomes