Depression in primary TKA and higher medical comorbidities in revision TKA are associated with suboptimal subjective improvement in knee function.

Jasvinder A Singh,David G Lewallen

doi:10.1186/1471-2474-15-127

Abstract

BackgroundTo characterize whether medical comorbidities, depression and anxiety predict patient-reported functional improvement after total knee arthroplasty (TKA).MethodsWe analyzed the prospectively collected data from the Mayo Clinic Total Joint Registry for patients who underwent primary or revision TKA between 1993–2005. Using multivariable-adjusted logistic regression analyses, we examined whether medical comorbidities, depression and anxiety were associated with patient-reported subjective improvement in knee function 2- or 5-years after primary or revision TKA. Odds ratios (OR), along with 95% confidence intervals (CI) and p-value are presented.ResultsWe studied 7,139 primary TKAs at 2- and 4,234 at 5-years; and, 1,533 revision TKAs at 2-years and 881 at 5-years. In multivariable-adjusted analyses, we found that depression was associated with significantly lower odds of 0.5 (95% confidence interval [CI]: 0.3 to 0.9; p = 0.02) of ‘much better’ knee functional status (relative to same or worse status) 2 years after primary TKA. Higher Deyo-Charlson index was significantly associated with lower odds of 0.5 (95% CI: 0.2 to 1.0; p = 0.05) of ‘much better’ knee functional status after revision TKA for every 5-point increase in score.ConclusionsDepression in primary TKA and higher medical comorbidity in revision TKA cohorts were associated with suboptimal improvement in index knee function. It remains to be seen whether strategies focused at optimization of medical comorbidities and depression pre- and peri-operatively may help to improve TKA outcomes. Study limitations include non-response bias and the use of diagnostic codes, which may be associated with under-diagnosis of conditions.

Highlights

To characterize whether medical comorbidities, depression and anxiety predict patient-reported functional improvement after total knee arthroplasty (TKA)
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, 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
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

Summary

Introduction

To characterize whether medical comorbidities, depression and anxiety predict patient-reported functional improvement after total knee arthroplasty (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 [17]. Such information can be very helpful to patients and policy makers. 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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