Question

Richard is a 72-year-old veteran with a history of end-stage bilateral knee osteoarthritis. He underwent right total knee arthroplasty (TKA) 3 days ago. He is currently taking oxycodone 5 mg with ibuprofen 800 mg three times daily for moderate post-op pain. He has a history of major depression that includes high levels of anxiety symptoms (anxious depression) which is treated with citalopram 20 mg daily and quetiapine 300 mg daily.
Which of the following is a risk factor for chronic persistent postsurgical knee pain in Richard?a. His ageb. His male genderc. His history of anxious depressiond. His continued use of oxycodone on postoperative day 3

Answer 1

c. His history of anxious depression

Explanation:

Medical comorbidities like anxiety and depression pre and postoperatively will lead to suboptimal or poor functional outcomes after total knee arthroplasty.  

Anxiety can increase the blood pressure which can lead to many postoperative complications after a TKA which in turn can result in poor outcomes from the surgery resulting in chronic pain.

A depressed patient will have a poor motivation to perform rehabilitative therapies in the postoperative period after TKA which are very vital for successful functional outcome of the operated knee. This also will lead to chronic persistent post-surgical knee pain.

Depression leads to dissatisfaction in the result after TKA which will make them feel pain.

Many studies have proved that anxiety and depressing will only lead to chronic pain syndrome among the elderly.