Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden, Huddinge, Sweden; Medical Research Internship, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Science Lund, Lund University, Lund, Sweden; The Swedish Arthroplasty Register, Göteborg, Sweden.
J Arthroplasty. 2024 Nov;39(11):2708-2713. doi: 10.1016/j.arth.2024.04.071. Epub 2024 May 1.
Remaining pain and functional limitations may cause dissatisfaction in patients after total knee arthroplasty (TKA). Furthermore, anxiety and depression are associated with remaining postoperative symptoms and dissatisfaction. We investigated if patient-reported anxiety or depression increased the risk of dissatisfaction 1 year after TKA in patients who improved in pain or function.
Data on primary TKAs due to osteoarthritis between 2017 and 2019 were obtained from the Swedish Knee Arthroplasty Register. Out of 14,120 patients, 9,911 completed the Knee injury and Osteoarthritis Outcome Score and satisfaction rate with the result of the surgery. According to the Outcome Measures in Rheumatology-Osteoarthritis Research Society International criteria patients were classified as responders (improved in pain or function) or nonresponders. Anxiety and depression were assessed through EuroQol-5 Dimension 3 levels. Log-linear regression models estimated the risk ratios (RRs) for dissatisfaction in all patients and stratified by age groups (< 65, 65 to 74, and > 74 years). There were 8,745 patients who were classified as responders whereas 11% were defined as dissatisfied. The proportion of patients who reported anxiety or depression was 35% preoperatively and 17% postoperatively.
Anxiety or depression increased the risk of dissatisfaction preoperatively (RR 1.23, 95% confidence interval = 1.09 to 1.40) and postoperatively (RR 2.65, confidence interval 2.33 to 3.00). Patients younger than 65 years reported preoperative anxiety or depression to a greater extent but did not have an increased risk of dissatisfaction.
Patient-reported anxiety or depression preoperatively and postoperatively are important and potentially treatable factors to consider, as they were found to increase the risk of dissatisfaction after TKA despite improvements in pain or function.
全膝关节置换术（TKA）后患者仍存在疼痛和功能受限可能会导致其不满意。此外，焦虑和抑郁与术后残余症状和不满意有关。我们研究了在疼痛或功能改善的 TKA 患者中，患者报告的焦虑或抑郁是否会增加 1 年后的不满风险。
从瑞典膝关节置换登记处获得了 2017 年至 2019 年间因骨关节炎进行的原发性 TKA 数据。在 14120 名患者中，9911 名患者完成了膝关节损伤和骨关节炎结局评分以及对手术结果的满意度评分。根据关节炎结果测量指标-骨关节炎研究学会国际标准，患者被分为应答者（疼痛或功能改善）或无应答者。焦虑和抑郁通过欧洲五维健康量表 3 水平进行评估。对数线性回归模型估计了所有患者和按年龄组（<65 岁、65-74 岁和>74 岁）分层的不满风险比（RR）。8745 名患者被归类为应答者，而 11%的患者被定义为不满意。术前报告有焦虑或抑郁的患者比例为 35%，术后为 17%。
术前（RR 1.23，95%置信区间 1.09 至 1.40）和术后（RR 2.65，置信区间 2.33 至 3.00）焦虑或抑郁增加了不满的风险。年龄小于 65 岁的患者术前报告有焦虑或抑郁的程度更大，但不满的风险没有增加。
尽管疼痛或功能改善，术前和术后患者报告的焦虑或抑郁是重要的、潜在可治疗的考虑因素，因为它们被发现会增加 TKA 后不满的风险。
