Does pre-operative anxiety and/or depression affect patient outcome after primary knee replacement arthroplasty?

Background: Chronic pain is associated with psychological distress, most commonly manifested as anxiety and/or depression. Methods: In order to investigate the effect of such distress on outcome from knee arthroplasty, we prospectively investigated the anxiety and depression levels of 104 patients undergoing a total of 107 primary knee arthroplasty procedures and the outcomes they achieved pre-operatively and at six weeks, one year and seven years post-operatively. The Hospital Anxiety and Depression Scale was used to record psychological status. Oxford Knee Score and American Knee Society Score were used to record functional outcomes. Results: Forty-four percent (47/107) of the patients had an abnormal pre-operative anxiety and/or depression score. Mean anxiety and depression scores improved at six weeks and one year of follow-up, but then deteriorated slightly at seven years, albeit not back to baseline. Knee scores showed similar patterns over time. Regardless of pre-operative psychological status, mean AKSS Knee scores improved at six weeks and further improved at one year post-op. They then showed slight deterioration at seven years, but remained significantly better than pre-op. Conclusions: Psychological distress is common in our patients pre-operatively. Improvements in knee pain and function as a result of surgery correlate well with lower levels of psychological distress post-operatively. Knee replacement surgery positively influences all of the outcome measures studied rather than recovery being negatively influenced by pre-operative states. Knee replacement arthroplasty is not contra-indicated by pre-operative psychological distress. Successful knee replacement improves knee pain and function, as well as symptoms of anxiety and depression. These improvements persist for many years after the surgery. (C) 2018 Elsevier B.V. All rights reserved.