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Sex‐Modified Effects of Depression, Low Back Pain, and Comorbidities on Pain After Total Knee Arthroplasty for Osteoarthritis
Author(s) -
Perruccio Anthony V.,
Fitzpatrick Jessica,
Power J. Denise,
Gandhi Rajiv,
Rampersaud Y. Raja,
Mahomed Nizar N.,
Davey J. Roderick,
Syed Khalid,
Veillette Christian,
Badley Elizabeth M.
Publication year - 2020
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.24002
Subject(s) - osteoarthritis , medicine , depression (economics) , physical therapy , comorbidity , knee pain , total knee arthroplasty , body mass index , arthroplasty , sex characteristics , prospective cohort study , chronic pain , surgery , alternative medicine , pathology , economics , macroeconomics
Objective The influence of sex on post–total knee arthroplasty ( TKA ) outcomes has been variable in the literature. Though sex is often reported as an averaged effect, we undertook this study to investigate whether sex modified the influence of presurgery characteristics on post‐ TKA knee pain. Methods This was a prospective study with data derived from 477 TKA osteoarthritis patients (279 women, 198 men). Questionnaires were completed presurgery and at 3 months postsurgery. The association between 3‐month post‐ TKA knee pain and presurgery covariates (body mass index, comorbidity count, symptomatic joint count, low back pain, knee pain, and depressive symptoms) was assessed by linear regression. Sex‐specific effects were evaluated using interactions. Results Women had significantly worse presurgery knee pain, joint count, and depressive symptoms, and worse postsurgery knee pain, than men. With simple covariate adjustment, no sex effect on pain was found. However, sex was found to moderate the effects of comorbidities (worse for women [ P = 0.013]), presence of low back pain (worse for men [ P = 0.003]), and depressive symptoms (worse for men [ P < 0.001]) on postsurgery pain. Worse presurgery pain was associated with worse postsurgery pain similarly for women and men. Conclusion The influence of some patient factors on early post‐ TKA pain cannot be assumed to be the same for women and men; average effects may mask underlying associations. Results suggest a need to consider sex differences in understanding TKA outcomes, which may have important implications for prognostic tool development in TKA .