Smoking, unemployment, female sex, obesity, and medication use yield worse outcomes in patellofemoral arthroplasty

Vishal S. Desai, Ayoosh Pareek, Casey M. DeDeugd, Orlando D. Sabbag, Aaron J. Krych, Nancy M. Cummings, Diane L. Dahm

Research output: Contribution to journalArticle

Abstract

Purpose: The purpose of this study was to identify effects of psychosocial and demographic factors on patellofemoral arthroplasty (PFA) outcomes. Methods: Patients who underwent PFA by a single surgeon between 2002 and 2013 (min. 2 year follow-up) were included. Knee Society scores (KSS), UCLA, and Tegner Scores were prospectively collected in a designated arthroplasty registry. Patient records were retrospectively reviewed and univariate and multivariate statistical analyses were performed to assess the effect of psychosocial factors and demographic variables including patient sex, BMI, smoking and medication use, psychiatric history, and employment status on improvement between pre- and post-operative scores. Results: Seventy-four knees in 55 patients (88% female) with a mean age of 51.8 (SD 8.8) and mean follow-up of 46.5 (SD 26.9) months were included. Patients showed significant improvement in all functional outcomes (p < 0.001). Mean improvement in KSS-F scores and median improvement in Tegner scores was greater in males compared to females (37.8 vs 16.1, p = 0.007; 3.0 vs 2.0, p = 0.07, respectively). Smokers showed less improvement in KSS-P compared to non-smokers (17.2 vs 30.0, p = 0.028). Retired or employed patients had a greater mean improvement in KSS-F and median improvement in Tegner Scores compared to those were unemployed or on work disability (p = 0.022, p = 0.01). Patients who reported using opioids and/or anti-depressants pre-operatively showed less improvement in UCLA scores (p = 0.006). Obese patients showed less improvement in both KSS-F and Tegner score compared to non-obese patients (p = 0.009, p = 0.004). Conclusion: Psychosocial factors influence the degree of improvement following PFA. Although patients showed overall improvement compared to their baseline scores, obese patients, smokers, unemployed/work disabled, and pre-operative use of opioids and/or anti-depressants were risk factors for decreased improvement… The consideration of psychosocial variables are clinically important when assessing a patient’s candidacy for PFA and improve pre-operative patient selection and counselling. Level of evidence: Level IV.

Original languageEnglish (US)
JournalKnee Surgery, Sports Traumatology, Arthroscopy
DOIs
StateAccepted/In press - Jan 1 2019

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Unemployment
Arthroplasty
Obesity
Smoking
Knee
Psychology
Opioid Analgesics
Demography
Patient Selection
Psychiatry
Registries
Counseling
Multivariate Analysis

Keywords

  • Anti-depressant
  • Employment
  • Opioids
  • Patellofemoral arthroplasty
  • Psychosocial
  • Smoking

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Smoking, unemployment, female sex, obesity, and medication use yield worse outcomes in patellofemoral arthroplasty. / Desai, Vishal S.; Pareek, Ayoosh; DeDeugd, Casey M.; Sabbag, Orlando D.; Krych, Aaron J.; Cummings, Nancy M.; Dahm, Diane L.

In: Knee Surgery, Sports Traumatology, Arthroscopy, 01.01.2019.

Research output: Contribution to journalArticle

Desai, Vishal S. ; Pareek, Ayoosh ; DeDeugd, Casey M. ; Sabbag, Orlando D. ; Krych, Aaron J. ; Cummings, Nancy M. ; Dahm, Diane L. / Smoking, unemployment, female sex, obesity, and medication use yield worse outcomes in patellofemoral arthroplasty. In: Knee Surgery, Sports Traumatology, Arthroscopy. 2019.
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abstract = "Purpose: The purpose of this study was to identify effects of psychosocial and demographic factors on patellofemoral arthroplasty (PFA) outcomes. Methods: Patients who underwent PFA by a single surgeon between 2002 and 2013 (min. 2 year follow-up) were included. Knee Society scores (KSS), UCLA, and Tegner Scores were prospectively collected in a designated arthroplasty registry. Patient records were retrospectively reviewed and univariate and multivariate statistical analyses were performed to assess the effect of psychosocial factors and demographic variables including patient sex, BMI, smoking and medication use, psychiatric history, and employment status on improvement between pre- and post-operative scores. Results: Seventy-four knees in 55 patients (88{\%} female) with a mean age of 51.8 (SD 8.8) and mean follow-up of 46.5 (SD 26.9) months were included. Patients showed significant improvement in all functional outcomes (p < 0.001). Mean improvement in KSS-F scores and median improvement in Tegner scores was greater in males compared to females (37.8 vs 16.1, p = 0.007; 3.0 vs 2.0, p = 0.07, respectively). Smokers showed less improvement in KSS-P compared to non-smokers (17.2 vs 30.0, p = 0.028). Retired or employed patients had a greater mean improvement in KSS-F and median improvement in Tegner Scores compared to those were unemployed or on work disability (p = 0.022, p = 0.01). Patients who reported using opioids and/or anti-depressants pre-operatively showed less improvement in UCLA scores (p = 0.006). Obese patients showed less improvement in both KSS-F and Tegner score compared to non-obese patients (p = 0.009, p = 0.004). Conclusion: Psychosocial factors influence the degree of improvement following PFA. Although patients showed overall improvement compared to their baseline scores, obese patients, smokers, unemployed/work disabled, and pre-operative use of opioids and/or anti-depressants were risk factors for decreased improvement… The consideration of psychosocial variables are clinically important when assessing a patient’s candidacy for PFA and improve pre-operative patient selection and counselling. Level of evidence: Level IV.",
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T1 - Smoking, unemployment, female sex, obesity, and medication use yield worse outcomes in patellofemoral arthroplasty

AU - Desai, Vishal S.

AU - Pareek, Ayoosh

AU - DeDeugd, Casey M.

AU - Sabbag, Orlando D.

AU - Krych, Aaron J.

AU - Cummings, Nancy M.

AU - Dahm, Diane L.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: The purpose of this study was to identify effects of psychosocial and demographic factors on patellofemoral arthroplasty (PFA) outcomes. Methods: Patients who underwent PFA by a single surgeon between 2002 and 2013 (min. 2 year follow-up) were included. Knee Society scores (KSS), UCLA, and Tegner Scores were prospectively collected in a designated arthroplasty registry. Patient records were retrospectively reviewed and univariate and multivariate statistical analyses were performed to assess the effect of psychosocial factors and demographic variables including patient sex, BMI, smoking and medication use, psychiatric history, and employment status on improvement between pre- and post-operative scores. Results: Seventy-four knees in 55 patients (88% female) with a mean age of 51.8 (SD 8.8) and mean follow-up of 46.5 (SD 26.9) months were included. Patients showed significant improvement in all functional outcomes (p < 0.001). Mean improvement in KSS-F scores and median improvement in Tegner scores was greater in males compared to females (37.8 vs 16.1, p = 0.007; 3.0 vs 2.0, p = 0.07, respectively). Smokers showed less improvement in KSS-P compared to non-smokers (17.2 vs 30.0, p = 0.028). Retired or employed patients had a greater mean improvement in KSS-F and median improvement in Tegner Scores compared to those were unemployed or on work disability (p = 0.022, p = 0.01). Patients who reported using opioids and/or anti-depressants pre-operatively showed less improvement in UCLA scores (p = 0.006). Obese patients showed less improvement in both KSS-F and Tegner score compared to non-obese patients (p = 0.009, p = 0.004). Conclusion: Psychosocial factors influence the degree of improvement following PFA. Although patients showed overall improvement compared to their baseline scores, obese patients, smokers, unemployed/work disabled, and pre-operative use of opioids and/or anti-depressants were risk factors for decreased improvement… The consideration of psychosocial variables are clinically important when assessing a patient’s candidacy for PFA and improve pre-operative patient selection and counselling. Level of evidence: Level IV.

AB - Purpose: The purpose of this study was to identify effects of psychosocial and demographic factors on patellofemoral arthroplasty (PFA) outcomes. Methods: Patients who underwent PFA by a single surgeon between 2002 and 2013 (min. 2 year follow-up) were included. Knee Society scores (KSS), UCLA, and Tegner Scores were prospectively collected in a designated arthroplasty registry. Patient records were retrospectively reviewed and univariate and multivariate statistical analyses were performed to assess the effect of psychosocial factors and demographic variables including patient sex, BMI, smoking and medication use, psychiatric history, and employment status on improvement between pre- and post-operative scores. Results: Seventy-four knees in 55 patients (88% female) with a mean age of 51.8 (SD 8.8) and mean follow-up of 46.5 (SD 26.9) months were included. Patients showed significant improvement in all functional outcomes (p < 0.001). Mean improvement in KSS-F scores and median improvement in Tegner scores was greater in males compared to females (37.8 vs 16.1, p = 0.007; 3.0 vs 2.0, p = 0.07, respectively). Smokers showed less improvement in KSS-P compared to non-smokers (17.2 vs 30.0, p = 0.028). Retired or employed patients had a greater mean improvement in KSS-F and median improvement in Tegner Scores compared to those were unemployed or on work disability (p = 0.022, p = 0.01). Patients who reported using opioids and/or anti-depressants pre-operatively showed less improvement in UCLA scores (p = 0.006). Obese patients showed less improvement in both KSS-F and Tegner score compared to non-obese patients (p = 0.009, p = 0.004). Conclusion: Psychosocial factors influence the degree of improvement following PFA. Although patients showed overall improvement compared to their baseline scores, obese patients, smokers, unemployed/work disabled, and pre-operative use of opioids and/or anti-depressants were risk factors for decreased improvement… The consideration of psychosocial variables are clinically important when assessing a patient’s candidacy for PFA and improve pre-operative patient selection and counselling. Level of evidence: Level IV.

KW - Anti-depressant

KW - Employment

KW - Opioids

KW - Patellofemoral arthroplasty

KW - Psychosocial

KW - Smoking

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