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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 11/2020

Open Access 01-11-2020 | Osteoarthrosis | Knee Arthroplasty

Preoperative psychological distress no reason to delay total knee arthroplasty: a register-based prospective cohort study of 458 patients

Authors: Aamir Mahdi, Maria Hälleberg-Nyman, Per Wretenberg

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 11/2020

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Abstract

Introduction

Total knee arthroplasty (TKA) is effective in alleviating pain and improving function in patients with knee arthritis. Psychological factors are known to affect patient satisfaction after TKA. It is important to determine the effectiveness of TKA in patients with presurgical anxiety and/or depression to avoid excluding them from surgery.

Materials and methods

A prospective cohort study was conducted on all patients who underwent TKA during 2016–2018. Patients were divided into four groups: with anxiety, without anxiety, with depression, and without depression. Outcome measures comprised both generic and knee-specific instruments. Each patient group was compared regarding changes in outcome measures one year after surgery. Between-group comparison was also performed.

Results

Of the 458 patients with complete data, 15.3% and 9.6% had experienced presurgical anxiety and depression, respectively. All patient groups displayed statistical (P < 0.001) and clinical improvement in all outcome measures. Patients with presurgical anxiety and/or depression generally displayed less improvement, though the only significant mean differences concerned the Knee Injury and Osteoarthritis Outcome Score (KOOS)-sport score in the non-anxiety and non-depression groups (P = 0.006 and 0.03, respectively), a higher proportion of clinically improved KOOS pain in the non-anxiety group (P = 0.03), and the general health state in the anxiety and depression groups (P = 0.004 and 0.04, respectively).

Conclusions

All patients improved in outcome measures 1 year after TKA, regardless of presurgical psychological state. Patients with presurgical anxiety and/or depression benefit greatly from surgery and should not be discriminated against based on presurgical psychological distress, though this fact should not eliminate the preoperative psychological assessment of patients.

Level of evidence

II.
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Metadata
Title
Preoperative psychological distress no reason to delay total knee arthroplasty: a register-based prospective cohort study of 458 patients
Authors
Aamir Mahdi
Maria Hälleberg-Nyman
Per Wretenberg
Publication date
01-11-2020
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 11/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-020-03537-w

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