{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T02:48:19Z","timestamp":1786589299798,"version":"build-2736575974"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T00:00:00Z","timestamp":1617840000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2021,5]]},"abstract":"Objective<\/jats:title>To assess the clinical benefit and compare the cost\u2010effectiveness of total knee arthroplasty (TKA) in patients with different personality traits.<\/jats:p><\/jats:sec>Methods<\/jats:title>The present study was retrospectively conducted from January 2017 to May 2018. A total of 232 patients between 46 and 71\u2009years old who underwent unilateral, primary TKA with the diagnosis of knee osteoarthritis were interviewed. Three types of data were required to compare the cost\u2010effectiveness differences among groups: personality traits, postoperative clinical outcomes about health\u2010related quality of life, and costs associated with TKA. Personality was assessed using the Eysenck Personality Questionnaire, functional outcome was assessed through the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, and costs were evaluated. Besides, the marginal cost\u2010effectiveness ratio (MCER) as the primary outcome, which relates the direct costs to the associated patient benefit as assessed by the clinical endpoint ($\/quality\u2010adjusted life years [QALY]), was compared among different personality traits. All information for this study was acquired by directly interviewing the patients and reviewing the medical computer records at our hospital.<\/jats:p><\/jats:sec>Results<\/jats:title>Two hundred and eleven patients completed the final analysis with an average of 24.6\u2009months follow\u2010up postoperatively. The choleric group, sanguine group, melancholic group, and phlegmatic group has 41, 70, 46, and 54 patients, respectively. A statistically significant difference in MECR, QALYs, and postoperative WOMAC existed among different personality traits (all P<\/jats:italic> <\u20090.05). There was no significant difference in mean age (P<\/jats:italic> =\u20090.588), body mass index (BMI) (P<\/jats:italic> =\u20090.790), smoking (P<\/jats:italic> =\u20090.934), heavy drinking (P<\/jats:italic> =\u20090.994), chronic comorbidities (all P<\/jats:italic> >\u20090.05), preoperative albumin <3.5 g\/dL (P<\/jats:italic> =\u20090.991), and American Society of Anaesthesiologists (ASA) score (P<\/jats:italic> =\u20090.687) among personality traits. More women tend to be melancholic in comparison to other personality traits (P<\/jats:italic> =\u20090.016). Melancholic patients attested inferiority of TKA compared with other personality traits, who would pay for the same QALYs at the highest costs (P<\/jats:italic> <\u20090.05). By contrast, sanguine patients have a more cost\u2010effective TKA than other personality traits, as they pay the least money for the same QALYs (P<\/jats:italic> <\u20090.05). Although phlegmatic and choleric patients seemingly have moderate gains from TKA, in general, the extroversion (measured by the extroversion subscale) and stability (measured by the neuroticism subscale) displayed more pleasurable QALYs in comparison with introversion and instability (P<\/jats:italic> <\u20090.05). Sensitivity analysis showed that the results mentioned above appeared not to be sensitive when varying key parameters (prosthesis survival and life expectancy) in a one\u2010way sensitivity analysis. Sanguine and melancholic patients still have the lowest and highest MCER in comparison with choleric and phlegmatic traits (P<\/jats:italic> <\u20090.05). The multivariate logistic regression showed that RA (adjusted OR<\/jats:italic> =\u20091.3, 95% CI<\/jats:italic> =\u20091.2\u20131.4, P<\/jats:italic> <\u20090.01), ASA Class I\u2013II (adjusted OR<\/jats:italic> =\u20090.9, 95% CI<\/jats:italic> =\u20090.8\u20131.0, P<\/jats:italic> <\u20090.001), sanguine (adjusted OR<\/jats:italic> =\u20090.8, 95% CI<\/jats:italic> =\u20090.7\u20130.9, P<\/jats:italic> <\u20090.001) and melancholic (adjusted OR<\/jats:italic> =\u20091.2, 95% CI<\/jats:italic> =\u20091.1\u20131.3, P<\/jats:italic> <\u20090.001) were significantly associated with MCER.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Before surgery, screening the melancholic patients would significantly reduce the economic burden, avoid unnecessary suffering, and shorten the recovery period.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13017","type":"journal-article","created":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T13:19:50Z","timestamp":1617887990000},"page":"1026-1035","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Personality Traits Affect the Cost\u2010Effectiveness of Total Knee Arthroplasty"],"prefix":"10.1111","volume":"13","author":[{"given":"Chao","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Orthopaedics Beijing Hospital of Traditional Chinese Medicine, Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying\u2010ying","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Psychology Hainan Hospital of Chinese PLA General Hospital Sanya China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"An","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Hainan Hospital of Chinese PLA General Hospital Sanya China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6040-7537","authenticated-orcid":false,"given":"Long","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, China\u2010Japan Friendship Hospital, Peking Union Medical College Chinese Academy of Medical College Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming\u2010sheng","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, China\u2010Japan Friendship Hospital, Peking Union Medical College Chinese Academy of Medical College Beijing China"},{"name":"Beijing University of Chinese Medicine Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi\u2010yuan","family":"Fang","sequence":"additional","affiliation":[{"name":"Beijing University of Chinese Medicine Beijing China"},{"name":"Dongfang Hospital Beijing University of Chinese Medicine Beijing 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