Kinesiophobia and depression affect total knee arthroplasty outcome in a multivariate analysis of psychological and physical factors on 200 patients

Purpose To evaluate the effects of kinesiophobia on the
outcomes of total knee arthroplasty (TKA), and to investigate
whether kinesiophobia represents an independent factor
influencing the surgery success or whether the observed
effects are driven by other physical or psychological
aspects such as anxiety and depression.
Methods Two hundred patients were evaluated prospectively
(mean age 65.7 ± 9.1 years, 134 women and 66 men) at
12 months after TKA. Kinesiophobia was assessed with the
Tampa Scale for kinesiophobia (TSK: Activity Avoidance—
TSK1 and Harm—TSK2 subscales); anxiety and depression
were assessed with STAI and BDI, respectively, and preoperative
pain and function, sex, age, BMI, education level, number
of painful joints and years of symptoms’ duration before
surgery were documented as well. Results were evaluated
with pain and function on 0–10 numeric rating scales, while
the overall clinical outcome was documented with WOMAC
and SF-12 (Physical and Mental subscales) scores.
Results TSK1 was correlated with WOMAC results at
12 months (p = 0.005, ρ = 0.197). STAI (p = 0.002,
ρ = 0.222), BDI (p < 0.0005, ρ = 0.307), and sex (p = 0.004) also influenced the outcome after TKA, while
other parameters, such as age, BMI, education level, and
number of painful joints and years of symptoms’ duration
before surgery, did not correlate with the clinical outcome.
The multivariate analysis confirmed the role of BDI
(p = 0.006, partial η2 = 0.038), TSK1 (p = 0.011, partial
η2 = 0.033), and sex (p = 0.048, partial η2 = 0.020), and
a synergic interaction of BDI and TSK1, which together
presented an even stronger correlation (p < 0.0005, partial
η2 = 0.111) with WOMAC at 12-month follow-up.
Conclusions Kinesiophobia is a factor influencing the outcome
after TKA independently from other psychological
and physical variables. This risk factor may affect TKA
results, especially in women, and shows a further synergic
interaction with depression in terms of lower surgical outcome.
These findings are of clinical relevance because they
show the impact of psychological factors such as kinesiophobia,
and suggest the possibility of adopting co-interventions
to overcome the fear of physical activity, and in the
end improve patient recovery and final outcome after TKA.
Level of evidence IV.