The Negative Impact of Preoperative Depression on Postoperative Functional Outcomes of Total Knee Arthroplasty

Background: Over 600 000 total knee arthroplasties (TKA) are performed per year in the United States, and about 20% of patients report poor and/or unsatisfactory outcomes following TKA. Additionally, about 22.5% of patients undergoing TKA meet clinical criteria for major depressive disorder. Previous research has revealed an association between preoperative depression and increased postoperative pain post-TKA. This review seeks to determine the relationship between preoperative depression and functional outcomes post-TKA. Methods: An exhaustive search of available medical literature was conducted using MEDLINE, CINAHL, and Web of Science. Keywords used included: “depression,” “preoperative depression,” “arthroplasty, replacement, knee,” and “total knee arthroplasty.” Included studies were assessed for quality using GRADE criteria. Results: Eighty-two studies were reviewed for relevancy, and three prospective cohort studies met inclusion criteria. Two studies revealed negative correlations between preoperative depression and poorer functional outcomes as measured by the Western Ontario and McMasters Osteoarthritis Index (WOMAC). The third study showed a significant independent relationship between preoperative depression as measured by the Hospital Anxiety and Depression Scale (HADS) and poorer performance on the Knee injury and Osteoarthritis Outcome Score (KOOS) ADL subscale. Conclusion: Across the three studies included in this systematic review, preoperative depressive symptoms are negatively associated with functional outcomes after TKA. Further research is necessary to determine the best treatment approach for TKA candidates with comorbid depression, especially if treating preoperative depression could potentially improve postoperative functional outcomes. Keywords: Depression, preoperative depression, and total knee arthroplast