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Assessing Recovery Across the Mental Health Spectrum After Total Knee Arthroplasty
Mathew Mendoza1, Dallas F Bennett1, Joshua H Taylor2
1Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA.
Background:
The rising prevalence of total knee arthroplasty (TKA) parallels increasing rates of anxiety and/or depression (Anx/Dep), yet the impact on recovery remains poorly defined. This study evaluates how Anx/Dep influences recovery and patient-reported outcomes after TKA, and whether Patient-Reported Outcomes Measurement Information System Global Health Short Form (10 items) (PROMIS-10) Mental Health T-scores provide additional insight.
Methods:
A retrospective review of 624 primary TKA patients (July 2023-October 2024) was performed. Patients were grouped by Anx/Dep diagnosis (309 with, 315 without) and stratified by PROMIS-10 Mental Health T-scores into below average mental health T-score (BA-MHT), average mental health T-score (A-MHT), and above average mental health T-score (AA-MHT) groups. PROMIS-10 physical, PROMIS-10 mental, and Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) scores were collected preoperatively and at 3, 6, and 12 months. Opioid use, pain, length of stay (LOS), and readmission rates were compared. Baseline demographic differences between groups were present.
Results:
Anx/Dep patients had significantly longer LOS, greater opioid use before discharge, and higher early postoperative pain. Although KOOS, JR scores were similar at 1 year, Anx/Dep patients reported consistently lower PROMIS-10 mental and physical scores (P < .0001). Mental health stratification revealed BA-MHT patients, regardless of diagnosis, had worse outcomes, including higher opioid use, longer LOS, and lower KOOS, JR and PROMIS-10 scores across all intervals. In contrast, AA-MHT patients demonstrated more favorable recovery.
Conclusions:
Anx/Dep is associated with increased early postoperative burden following TKA. PROMIS-10 mental health scores better capture variation in recovery, suggesting that mental health influences outcomes along a continuum rather than a binary diagnosis. Routine PROMIS-10 screening may help identify at-risk patients and guide personalized care strategies.