Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT.
University of Connecticut School of Medicine, Farmington, CT.
J Arthroplasty. 2020 Jan;35(1):28-31. doi: 10.1016/j.arth.2019.08.010. Epub 2019 Aug 9.
The objective of this study was to investigate if there were differences in disease-specific, overall health, and activity outcomes after total joint arthroplasty (TJA) between treated and untreated depressed patients.
Patients who underwent primary, elective, unilateral TJA were divided into 3 groups based on self-reported history of depression and treatment at the time of surgery: 1) patients without depression, 2) patients with treated depression, and 3) patients with untreated depression. The primary outcomes were the differences in SF-12 PCS, SF-12 MCS, WOMAC, and UCLA activity rating scale up to 12 months postoperatively. A secondary outcome was the effect of depression treatment on patients' perception of experiencing limitation in their activities due to depression. Univariate and mixed-effects model analyses were performed to control for potential confounding factors.
The prevalence of depression was 189/749 (25%). Compared to patients with treated depression, untreated patients had lower baseline SF-12 MCS (P < .001) and were more likely to have Medicaid insurance (P < .001). After controlling for potential confounding factors, there were no differences in either the absolute scores or net changes in any of the assessed outcomes at 12 months postoperatively among depressed patients regardless of treatment (P > .05). In addition, depression treatment did not affect patients' perception of activity limitation (P = .412).
Although it is clear that depression adversely impacts patient outcomes in primary TJA, treatment does not appear to mitigate this negative effect. Depression treatment does not necessarily imply resolution of depressive symptoms. Future studies should explore alternative interventions to reduce the health-related consequences of depression to optimize the outcomes of TJA.
本研究旨在探讨在接受全关节置换术（TJA）的患者中，是否存在治疗和未治疗的抑郁患者在疾病特异性、总体健康和活动结果方面的差异。
根据手术时的自我报告抑郁史和治疗情况，将接受初次、择期、单侧 TJA 的患者分为 3 组：1）无抑郁患者，2）治疗抑郁患者，3）未治疗抑郁患者。主要结果是术后 12 个月 SF-12 PCS、SF-12 MCS、WOMAC 和 UCLA 活动评分量表的差异。次要结果是抑郁治疗对患者因抑郁而感到活动受限的感知的影响。进行了单变量和混合效应模型分析，以控制潜在的混杂因素。
抑郁的患病率为 189/749（25%）。与治疗抑郁的患者相比，未治疗的患者 SF-12 MCS 基线水平较低（P<.001），并且更有可能拥有医疗补助保险（P<.001）。在控制潜在混杂因素后，无论治疗情况如何，在术后 12 个月时，抑郁患者在任何评估结果的绝对评分或净变化方面均无差异（P>.05）。此外，抑郁治疗并未影响患者对活动受限的感知（P=.412）。
尽管很明显抑郁会对初次 TJA 的患者结局产生不利影响，但治疗似乎并不能减轻这种负面影响。抑郁治疗并不一定意味着抑郁症状的解决。未来的研究应探索减少抑郁对健康相关后果的替代干预措施，以优化 TJA 的结果。
