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Depression linked with suboptimal improvement after TKA
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Results of this study associate suboptimal improvement in index knee function with depression and higher medical comorbidity scores in patients who undergo primary total knee arthroplasty and revision total knee arthroplasty, respectively.
Researchers analyzed data collected from the Mayo Clinic Total Joint Registry on patients who underwent either primary or revision total knee arthroplasty (TKA) between 1993 and 2005. Researchers used multivariable-adjusted logistic regression analyses to examine whether medical comorbidities, depression and anxiety were associated with subjective improvement in knee function 2- or 5-years following the TKA.
Overall, 7,139 primary and 1,533 revision TKAs were studied with 2-year follow-up. Five-year follow-up was available for 4,234 primary and 881 revision TKAs. Two years after primary TKA, analyses showed an association between depression and a significantly lower odds of 0.5 for much better knee function. Researchers also found an association between a higher Deyo-Charlson index and a lower odds of 0.5 for much better knee function after revision TKA for every 5-point increase in score.
“These findings clarify the role of medical and psychological comorbidity in functional improvement in the index knee after TKA. Patients with depression may benefit by optimization of behavioral and medical therapy for depression prior to and after primary TKA,” the researchers wrote in the study conclusion. “Similarly, closer management of medical comorbidities may have an impact on functional outcomes after revision TKA. Patients with higher medical comorbidity load and/or depression should be warned about suboptimal knee function outcome. Future results from the ongoing AHRQ-funded U.S. registry study should help to identify additional factors associated with functional outcomes after TKA.”
Disclosure: Singh received research and travel grants from Takeda and Savient, as well as consulting fees from Savient, Takeda, Regeneron and Allergan. Lewallen received royalties/speaker fees from Zimmer, Orthosonic and Osteotech, and is a paid consultant and owns stock in Pipeline Biomedical.
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