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

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.

“I am accustomed to something in my body causing pain”: a qualitative study of knee replacement non-improvers’ stories of previous painful and stressful experiences

“…A recent meta-analysis concludes that OA patients should be screened for anxiety and depression for better pain management and to increase clinical awareness around the association between psychological aspects and persistent pain [ 46 ]. However, eligibility for surgery should not be influenced by preoperative anxiety or depression symptoms [ 47 , 48 ]. In addition, OARSI guidelines suggest that patients’ clinical status may improve before surgery if they are contacted regularly by phone [ 1 ].…”

Carpal Tunnel Syndrome and Ulnar Nerve Entrapment Are Associated with Impaired Psychological Health in Adults as Appraised by Their Increased Use of Psychotropic Medication

“…Thus, the indication for surgery for UNE should be very clear and sometimes strict. An interesting question is if patients with preoperative anxiety and/or depression benefit from a specific type of surgery, but data indicate that patients, surgically treated with a total knee arthroplasty, are improved regardless of their presurgical psychological status [30]. Preoperative information, where also assessment of the psychological and psychiatric status is considered before surgery, seems to be crucial [31] and anxiety and depression symptoms may also decrease after a total knee arthroplasty [32].…”

What is the Association Between Clinically Diagnosed Psychiatric Illness and Total Joint Arthroplasty? A Systematic Review Evaluating Outcomes, Healthcare Use, and Patient-reported Outcome Measures

“…The full text of each article was reviewed, 21 of which fulfilled our inclusion criteria. Most full-text screened articles that were excluded did not use clinical diagnoses to verify the presence of a psychiatric disorder [1-4, 6, 8, 10, 16, 19, 21, 23-25, 29-43, 46, 52, 56, 58, 61, 62, 64, 66, 67, 72, 76, 80, 85-89, 92, 93]. A review of each study’s reference list did not yield any additional articles (Fig.…”

“…Studies evaluating the association between psychiatric illness and orthopaedic surgical outcomes have yielded mixed results. This may be partly explained by variations in how psychiatric illness is identified, with some studies using preoperative surveys and others ensuring that appropriate clinical diagnostic criteria have been met among studied patient populations [8,21,37,52,70,76]. Although some studies have reported worse perioperative outcomes among patients with diagnosed psychiatric illnesses [45,48,73,83,84], other research suggests these patients have a lower risk of complications, shorter lengths of stay (LOS), and higher costs of care than patients without a psychiatric illness [11,59,78].…”