Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Total knee arthroplasty was found to decrease the incidence of depression among patients to 85% at 6 months follow-up.

2. Higher pre-operative Beck’s Depression Scale scores corresponded to worse knee function scores post-operatively.

Evidence Rating Level: 2 (Good)

Knee surgical procedures in relation to osteoarthritis are increasingly common due to rising life expectancy, but they entail complications, leading to higher financial burdens, reduced recovery time, and lower quality of life. Depression, with an estimated prevalence of 29.9% has negative postoperative outcomes after knee surgery. This cross-sectional study recruited 150 patients undergoing primary total knee arthroplasty to explore the occurrence of depression symptoms in this population and assess how pre-operative depressive symptoms independently predict various health-related quality of life measurements. Pre-operatively, 99.3% of the recruited subjects were classified as moderate to severely depressed according to the Beck’s Depression Scale. At 3 months postoperative, 76% (n=114) demonstrated mild depression and 24% (36) were considered border-line depression. At the 6-month follow-up period, 85% (128) of patients were classified as normal, while 15% experienced mild depression. Post-surgery, a significant improvement was observed in knee function scores namely the Knee Society Score (KSS) function scale (P < 0.001) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale (P < 0.001). Regression analysis indicated that increased time elapsed since the procedure (P<0.001), higher Beck’s Depression Scale scores, and lower (worse) baseline KSS physical functioning scores corresponded to higher (worse) WOMAC scores. Overall, these findings suggest a bidirectional relationship between mental health and surgical outcomes—surgery confers significant improvements in mental health status, whereas worse pre-operative mental health status predicts poorer surgical outcomes.

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