Summary

Preoperative depression or anxiety was concerningly common, reported by half the cohort. Significant improvements were observed as the prevalence of moderate to severe DA reduced by 75% after TKA. Improvement in depression or anxiety is a realistic expectation of knee arthroplasty.

Abstract

Background

Chronic pain is known to be associated with depression and anxiety (DA) and is the predominant feature of advanced stage osteoarthritis of the knee. The aim of this study was to assess the level of DA in a knee arthroplasty (TKA) cohort, determine if improvements in DA were observed after TKA, and assess the effect of DA on outcomes.

Methods

Participants underwent primary TKA for osteoarthritis and consented to participation in a research database with baseline PROMS, including Oxford Knee Score, and EQ5D. DA was assessed with the EQ-5D, a self-reported, generic health measure with five severity levels scored from 1 (none) to 5 (extreme). Participants repeated PROMS at 12 months after surgery with additional questions regarding satisfaction with surgery. Outcomes were compared across levels of baseline DA.

Results

Of the 2024 patients, 1897 (94%) completed PROMS 1 year after TKA with rating of depression or anxiety. The mean age was 66 years (range 29-99) and there were 1003 females (53%). Before surgery DA was graded as none 50%, some 30%, moderate 15%, severe 4% and extreme 1%. After TKA, DA was graded as none in 80%, some in 15%, moderate in 4% and severe or extreme in 1%. Moderate to severe DA reduced from 20% to 5% after TKA (p=0.001). Rates of baseline DA were similar between genders (p=0.215). For those with any DA preoperatively, 67% reported none after TKA. For those with moderate to extreme DA preoperatively, 85% reported improved DA after TKA. Preoperative DA did not affect the rates of satisfaction (p=0.203), or the proportion reporting to have the same surgery again under the same circumstances (p=0.242). Worsening levels of DA was associated with progressively lower baseline Oxford (p=0.001), KOOS JR (p=0.001), and general health (p=0.001) scores. Those with moderate to severe DA preoperatively experienced greater improvements in median Oxford (p=0.001), KOOS JR (p=0.035) and General Health (p=0.001), than those no or mild DA.

Conclusion

Preoperative depression or anxiety was concerningly common, reported by half the cohort. Significant improvements were observed as the prevalence of moderate to severe DA reduced by 75% after TKA. In those with baseline moderate to extreme DA, 85% reported improvement in DA at 1 year. Those with DA had lower baseline scores, but experienced equivalent or greater improvement in disease specific and general health scores after surgery, and rates of satisfaction with surgery. Improvement in depression or anxiety is a realistic expectation of knee arthroplasty.