Robotic-specific patient education reduces preoperative anxiety and improves outcomes after total knee arthroplasty

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Abstract
The purpose of this study was to evaluate whether standardized robotic-specific patient information was associated with sustained reduction in preoperative anxiety in patients undergoing robotic-assisted TKA, and whether the reduction in anxiety was associated with improved postoperative outcomes and clinically meaningful recovery. This retrospective cohort study evaluated 106 patients who underwent primary unilateral robotic-assisted TKA. Anxiety was assessed using the Hospital Anxiety and Depression Scale–Anxiety subscale(HADS-A) at baseline, immediately after robotic-specific patient information, and preoperatively. Perceived reassurance was measured using a 5-item Likert-type module. Postoperative outcomes included Visual Analog Scale(VAS) pain, Oxford Knee Score(OKS), and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) scores at 6 weeks and 12 months. Multivariable regression analyses adjusted for baseline scores and relevant covariates were performed. Clinically meaningful recovery was evaluated using established minimal clinically important difference(MCID) and patient acceptable symptom state(PASS) thresholds. Mean anxiety scores decreased significantly from baseline to post-information and preoperative assessments(12.7 to 11.0 to 9.7; P < .001). Higher perceived reassurance was strongly associated with greater anxiety reduction(ρ = 0.92; P < .001). Greater anxiety reduction remained independently associated with improved postoperative outcomes, including higher OKS at 12 months(adjusted β = 2.00; 95% CI 1.56–2.43; P < .001), lower WOMAC scores(adjusted β = −3.03; 95% CI −3.90 to −2.17; P < .001), and lower VAS pain(adjusted β = −0.22; 95% CI −0.35 to −0.09; P < .001). Greater anxiety reduction also was associated with achievement of MCID and PASS thresholds at 12 months(P < .001). Standardized robotic-specific patient information was associated with sustained preoperative anxiety reduction and greater anxiety reduction was in turn associated with better postoperative pain, function, and clinically meaningful recovery after robotic-assisted total knee arthroplasty.

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