Gebauer Sarah C, Salas Joanne, Tucker Jane L, Callahan Leigh F, Scherrer Jeffrey F
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri.
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.
J Arthroplasty. 2024 Oct;39(10):2452-2457.e2. doi: 10.1016/j.arth.2024.05.023. Epub 2024 May 10.
Depression is common in osteoarthritis (OA) and is associated with poor outcomes following total knee arthroplasty (TKA). Depression can increase pain sensitivity and may be related to an increased likelihood of TKA.
Nationally distributed electronic health record data from 2010 to 2018 were used to identify eligible patients (n = 9,466) who had knee OA and were 45 to 80 years of age. Cox proportional hazard models were computed to estimate the association between depression and incident TKA for all patients and by age group (45 to 54, 55 to 64, and 65 to 80 years of age). Confounding was controlled using entropy balancing. Sensitivity analyses determined if the association between depression and TKA differed when depression occurred in the 12 months occurring 90, 60, 30, and 0 days lag time before TKA.
The mean age of the sample was 63 (range, 45 to 80), 64.0% were women, 83.3% were White race, and approximately 50% resided in the Midwest. There was no association between depression and incident TKA (hazard ratio = 0.97; confidence interval = 0.81 to 1.16]). Results did not differ in age-stratified analyses. Sensitivity analyses revealed a higher percentage of TKA among depressed versus nondepressed patients (24.2 versus 21.6%; P = .028) when the patient's depression diagnosis was established in the 12 months with no lag time before TKA.
Patients who have knee OA and comorbid depression, compared to those who have only knee OA, do not have an increased likelihood of TKA. The multifactorial, complex decision to obtain TKA does not appear to be influenced by depression, but depression is a common comorbidity.
抑郁症在骨关节炎（OA）中很常见，并且与全膝关节置换术（TKA）后的不良预后相关。抑郁症会增加疼痛敏感性，可能与TKA可能性增加有关。
使用2010年至2018年全国范围内分布的电子健康记录数据来确定符合条件的患者（n = 9466），这些患者患有膝关节OA，年龄在45至80岁之间。计算Cox比例风险模型，以估计所有患者以及按年龄组（45至54岁、55至64岁和65至80岁）划分的抑郁症与TKA发生率之间的关联。使用熵平衡控制混杂因素。敏感性分析确定了在TKA前90、60、30和0天的12个月内发生抑郁症时，抑郁症与TKA之间的关联是否不同。
样本的平均年龄为63岁（范围为45至80岁），64.0%为女性，83.3%为白人，约50%居住在中西部地区。抑郁症与TKA发生率之间没有关联（风险比 = 0.97；置信区间 = 0.81至1.16）。年龄分层分析结果无差异。敏感性分析显示，当患者的抑郁症诊断在TKA前无滞后时间的12个月内确定时，抑郁症患者的TKA百分比高于非抑郁症患者（24.2%对21.6%；P = 0.028）。
与仅患有膝关节OA的患者相比，患有膝关节OA合并抑郁症的患者进行TKA的可能性并未增加。进行TKA这一多因素、复杂的决定似乎不受抑郁症影响，但抑郁症是一种常见的合并症。
