Depression and Comorbidities Affect Knee Function After TKA
Depression and Comorbidities Affect Knee Function After TKA
Total knee arthroplasty (TKA) is a very successful surgery for patients with end-stage arthritis. TKA is associated with significant improvements in pain, function and quality of life. Related to the obesity epidemic, increasing longevity and the expansion of TKA indications to both younger and older patients, the annual incidence of TKA is increasing at an exponential rate. Post-TKA functional limitations constitute a significant problem. We need a better understanding of factors associated with failure to improve index knee function after TKA.
Previous studies examining the effect of medical and psychological comorbidity on knee function after TKA have provided contradictory results. Some studies found that higher medical comorbidity was associated with poorer function, but others reported no association. Similarly, some studies reported that depression was associated with poor functional outcomes after TKA, but others did not. While the reasons for these contradictory findings are unclear, there is clearly a lack of consistent evidence of association of medical and psychological comorbidity with knee function after TKA. Not surprisingly, a recent systematic review of psychological factors affecting outcomes of knee or hip arthroplasty concluded "…strong evidence was found that preoperative depression had no influence on postoperative functioning". Four key limitation of most previous studies were that: (1) they consisted of small sample sizes and were likely underpowered; (2) multivariable-adjustment for potential confounders was not done in all studies, thereby increasing the possibility of bias; (3) they provided a mean change in function score at the cohort level (averaging of excellent, good and poor results), which is difficult to extrapolate to patient level benefit, varying in their improvement in function after TKA; and (4) very few studies included patients with revision TKA. An easier way to understand arthroplasty results is to examine the proportion of patients who achieve a clinically meaningful improvement in function, reported only rarely in arthroplasty studies. Such information can be very helpful to patients and policy makers. Thus, we need better-designed studies. The aim of this study was to examine whether medical and psychological comorbidity at the time of TKA associated with a clinically meaningful function improvement after TKA. We hypothesized that higher medical comorbidity, depression and anxiety at the time of TKA, will each be independently associated with poorer patient-reported subjective functional outcome after primary and revision TKA.
Background
Total knee arthroplasty (TKA) is a very successful surgery for patients with end-stage arthritis. TKA is associated with significant improvements in pain, function and quality of life. Related to the obesity epidemic, increasing longevity and the expansion of TKA indications to both younger and older patients, the annual incidence of TKA is increasing at an exponential rate. Post-TKA functional limitations constitute a significant problem. We need a better understanding of factors associated with failure to improve index knee function after TKA.
Previous studies examining the effect of medical and psychological comorbidity on knee function after TKA have provided contradictory results. Some studies found that higher medical comorbidity was associated with poorer function, but others reported no association. Similarly, some studies reported that depression was associated with poor functional outcomes after TKA, but others did not. While the reasons for these contradictory findings are unclear, there is clearly a lack of consistent evidence of association of medical and psychological comorbidity with knee function after TKA. Not surprisingly, a recent systematic review of psychological factors affecting outcomes of knee or hip arthroplasty concluded "…strong evidence was found that preoperative depression had no influence on postoperative functioning". Four key limitation of most previous studies were that: (1) they consisted of small sample sizes and were likely underpowered; (2) multivariable-adjustment for potential confounders was not done in all studies, thereby increasing the possibility of bias; (3) they provided a mean change in function score at the cohort level (averaging of excellent, good and poor results), which is difficult to extrapolate to patient level benefit, varying in their improvement in function after TKA; and (4) very few studies included patients with revision TKA. An easier way to understand arthroplasty results is to examine the proportion of patients who achieve a clinically meaningful improvement in function, reported only rarely in arthroplasty studies. Such information can be very helpful to patients and policy makers. Thus, we need better-designed studies. The aim of this study was to examine whether medical and psychological comorbidity at the time of TKA associated with a clinically meaningful function improvement after TKA. We hypothesized that higher medical comorbidity, depression and anxiety at the time of TKA, will each be independently associated with poorer patient-reported subjective functional outcome after primary and revision TKA.
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