Depression Is Not Independently Associated with a Clinically Worse Functional Improvement but Associated with a Lower Reported Satisfaction Rate after Total Knee Arthroplasty

Abstract

The aim of this study was to assess whether depression had a clinically significant influence on the functional improvement of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and whether it influences patient satisfaction at 1 year. A retrospective cohort of 3,510 primary TKA was identified from an arthroplasty database. Patient demographics, comorbidities, WOMAC, and Short Form-12 (SF-12) scores were collected preoperatively and 1 year postoperatively. Patient satisfaction (overall, pain relief, return to work, and recreational activity) was assessed at 1 year. There were 444 (12.6%) patients who self-reported depression. Patients with depression were younger (p < 0.001), had a higher body mass index (BMI; p < 0.001), were more likely to be female (p < 0.001), had lung (p < 0.001), neurological (p = 0.018), kidney (p = 0.001), liver (p < 0.001), and gastric (p < 0.001) disease, report associated diabetes (p = 0.001), and back pain (p < 0.001) relative to the subgroup without depression. All preoperative WOMAC functional measures were significantly (p < 0.001) worse in patients with reported depression. When adjusting for these confounding differences, patients with depression had a clinically equal improvement in their WOMAC scores at 1 year compared to those patients without. Depression was not associated with a clinically significant difference in improvement of knee-specific outcome (WOMAC) but was independently associated with a lower rate of patient satisfaction 1 year after TKA. Patients with depression were approximately twice as likely to be dissatisfied at 1 year when compared with those without depression. This is a prognostic retrospective cohort study and reflects level of evidence III.

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“…Several studies have shown that delaying hip and knee arthroplasty results in a worse preoperative functional score which is subsequently associated with a worse postoperative health state 17 and lower rate of patient satisfaction. 18 - 20 The effect of the COVID-19 pandemic on patient outcome will likely be difficult to quantify in the future, with patients living for longer with their disability and potentially having a worse outcome due to their delayed surgery. 17 , 21 This should be assessed in future studies.…”

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“…It may be that there are other ways to intervene, pre-and postoperatively, to improve satisfaction and outcome in TKA. Multiple preoperative factors have been associated with low postoperative satisfaction such as preoperative depression, preoperative opioid use, unrealistic preoperative expectations, and poor communication [1,[5][6][7]. Perhaps interventions on factors such as these can be more impactful on subjective TKA outcomes and less costly than introducing new technology.…”