The importance of psychologic distress and illness behavior is well recognized in low-back pain but has rarely been studied in other orthopedic conditions. Psychologic and clinical assessment of 100 patients undergoing elective surgery for minor leg conditions or joint replacement for osteoarthritis or rheumatoid arthritis showed surprisingly little psychologic distress or illness behavior, particularly when compared with 235 patients with low-back pain. The most striking finding was that in low-back pain there was a close relation between psychologic disturbance and failed surgery, but the nonspinal patients showed a complete absence of such a relation. This type of psychologic assessment is neither necessary nor helpful in the routine management of most clearly defined, nonspinal, correctly managed orthopedic conditions.
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