Journal
PAIN MEDICINE
Volume 20, Issue 4, Pages 826-833Publisher
OXFORD UNIV PRESS
DOI: 10.1093/pm/pny107
Keywords
Depression; Orthopaedic Surgery; Physical Function; Quality of Life; Postoperative Outcomes
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Objective The purpose of this paper is to analyze the impact of major depressive disorder, both preoperatively and one year postoperatively, on the functional and psychosocial outcomes of total knee arthroplasty (TKA). Methods Two hundred sixty patients undergoing a total knee arthroplasty completed both the baseline and 12-month follow-up assessments. Short-Form Health Inventory (SF36), Western Ontario and McMaster University Arthritis Index (WOMAC), and Knee Society Score (KSS) were measured both preoperatively and postoperatively. The Patient Health Questionnaire (PHQ) was used to diagnose major depressive disorder (MDD) at baseline and follow-up; patients were then classified into one of four groups: No MDD, Lost MDD, Gained MDD, and Continuous MDD. Univariate analysis compared the four groups at baseline, one-year follow-up, and change scores using a Kruskal-Wallis test for continuous data or a chi-square test of independence for categorical data. Results Two hundred seven (79.60%) patients were in the No MDD group, 22 (8.50%) patients were in the Lost MDD group, 19 (7.30%) patients were in the Gained MDD group, and 12 (4.60%) patients were in the Continuous MDD group. There were significant between-group differences present in baseline measures of WOMAC and SF36 mental health summary. In addition, there were significant group differences in the follow-up WOMAC, KSS, and SF36 scores. Conclusions Depression was associated with poorer preoperative and postoperative TKA scores. Patients who were depressed 12months after surgery demonstrated poorer recovery than patients who did not show depressive symptoms before TKA or within the year after.
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