Depression negatively affects patient-reported knee functional outcome after intraarticular hyaluronic acid injection among geriatric patients with knee osteoarthritis

Yu-Pin Chen,Chung-Ying Lin,Yueh Wu,Yu-Yun Huang,Yi-Jie Kuo

doi:10.1186/s13018-019-1419-z

Abstract

PurposeIntraarticular hyaluronic acid injection (IAHA) is a popular treatment for knee osteoarthritis (OA). This study investigates whether depression, anxiety, and pain affect self-reported knee function in geriatric OA people who have received IAHA.MethodsThrough convenience sampling, 102 geriatric patients (mean age = 70.91 ± 7.19; 28 males) with knee OA who had undergone IAHA participated in this study. All participants self-reported depression using the Geriatric Depression Scale (GDS), anxiety using the State-Trait Anxiety Inventory (STAI), knee function using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the International Knee Documentation Committee subjective knee evaluation form (IKDC), and pain severity using the Visual Analogue Scale (VAS). They completed the aforementioned questionnaires at baseline before injection and then again at 2-, 4-, and 6-month follow-ups.ResultsDepression was significantly associated with IKDC, WOMAC physical function subscale, and total WOMAC scores. Anxiety was only significantly associated with the WOMAC pain subscale score. Pain severity was significantly associated with IKDC, WOMAC stiffness subscale, WOMAC physical function subscale, and total WOMAC scores.ConclusionGiven that depression negatively affected patient-reported knee function among geriatric OA patients who had undergone IAHA, further attention should be paid to the depressive status of this population.

Highlights

Osteoarthritis (OA) commonly affects middle-age to elderly people, with an incidence of symptomatic knee OA up to 10% of men and 13% of women aged 60 years or older [1,2,3]
10% of the geriatric population suffers from severe anxiety and depressive symptoms [10]
This study demonstrates that knee pain and depression were the factors that most strongly and negatively affect the patient-reported knee functional outcomes, including IKDC and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores, of elderly patients with knee OA who had undergone Intraarticular hyaluronic acid injection (IAHA)

Summary

Introduction

Osteoarthritis (OA) commonly affects middle-age to elderly people, with an incidence of symptomatic knee OA up to 10% of men and 13% of women aged 60 years or older [1,2,3]. Chen et al Journal of Orthopaedic Surgery and Research (2019) 14:387 reported to gain the best benefit from IAHA treatment than the elderly population [8]. To maximize the treatment effects of IAHA, factors that potentially hinder those treatment effects for the elderly must be investigated. Knee OA is reportedly associated with depressive symptoms especially among geriatric population [9]. 10% of the geriatric population suffers from severe anxiety and depressive symptoms [10]. A study in six European countries has demonstrated that severe and stable joint pain is associated with anxiety and depressive symptoms among older adults with knee OA [11]. To the best of our knowledge, there is a lack of reports on psychological factors associated with the self-reported outcomes in geriatric OA people undergoing IAHA

Methods

Results

Discussion

Conclusion