Do preoperative anxiety and depression influence the outcome of knee arthroplasty?

The association of depression and chronic pain in knee osteoarthritis is a complex and difficult phenomenon to understand. In fact, establishing the order of appearance of these entities might result in an arduous task.

In addition to analyzing the relationship between preoperative anxiety and depression according to the results of total knee arthroplasty (TKA), we will assess the evolution of anxiety and depression symptoms.

A study of 260 patients with a mean age of 70.8 years. Patients were evaluated preoperatively and one year post-surgery completing the Knee Society Score (KSS), the Visual Analogue Scale (VAS), the Hospital Anxiety and Depression Scale (HADS) for the assessment of anxiety and depression, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for quality of life.

The mean scores of preoperative depression and anxiety decreased postoperatively from 6.55/7.63 to 4.96/5.96, respectively, a reduction that was statistically significant (P<.001). The differences between the preoperative scores and the 1-year scores of the different groups classified by HADS for both anxiety and depression were statistically significant (P˂.001). The differences in VAS scores (P=.02) showed a significant improvement in patients with preoperative anxiety, in contrast to depressed patients.

TKA has proved to significantly decrease the preoperative levels of anxiety and depression. In patients with preoperative anxiety, the decrease in pain levels measured by the VAS was greater after TKA. Preoperative anxiety and depression did not influence the functional results of the TKA measured by the KSS.