Is There a Change in Anxiety and Depression Following Total Knee Arthroplasty?

BACKGROUND: The primary purpose of this study was to investigate whether anxiety and depression change following total knee arthroplasty (TKA). A secondary objective was to explore the association between pre-operative variables and changes in anxiety and depression.

METHODS: This was a prospective, multicenter, cohort study. Participants (n = 1,852, age 64 + 8.7 years, a BMI of 31.3, a modified Comorbidity Index of 1.0 + 1.3, and 61.7% were women) completed the EuroQol 5-dimension 5-level (EQ-5D-5L) pre-operatively and at one- and three-months post-operatively. Fulfillment of physical activity expectations and preparedness to resume activities was assessed at three months. The anxiety or depression dimension was analyzed using the Paretian classification profile changes and compared with the sign Fisher's exact test. Logistic regressions were used to analyze the relationship between patient characteristics, pre-operative anxiety or depression, activity expectations, preparedness to resume activities, and changes in anxiety/depression.

RESULTS: The percentage of patients reporting Level 1 (no anxious or depressed feelings) significantly (P < 0.0001) increased from pre-operative (62.2%) to three months (77.1%) post-operative, while levels 2 to 5 (slightly through extremely anxious or depressed) all decreased. The percentage of worsening anxiety and depression was significantly (P < 0.0001) greater in patients who did not feel they were well prepared to resume activities of daily living (ADL) (17.7 versus 4.4%) and physical recreation (12.9 versus 3.9%). Pre-operative anxiety and depression (OR [odds raio] 52.27, 95% CI [confidence interval]: 34.98, 80.67), EQ-5D-5L (OR: 2.55, 95% CI: 1.04, 6.34), ADL (OR: 1.57, 95% CI: 1.19, 2.06), and BMI (OR: 1.05, 95% CI: 1.02, 1.08) were significant (P < 0.05) predictors of an improving Paretian change profile at three-months post-operative.

CONCLUSION: Anxiety and depression decrease following TKA, and these changes appear heavily dependent on a patient's pre-operative psychological well-being and post-operative preparedness to resume daily activities. Physicians' awareness of pre-operative patient psychological well-being and management of patient preparedness and expectations to resume physical activity may modulate post-operative anxiety and depression.