Bensa Alessandro, Bianco Prevot Luca, Piano Andrea, Peretti Giuseppe M, Filardo Giuseppe
Service of Orthopaedics and Traumatology Department of Surgery, EOC Lugano Switzerland.
Università della Svizzera Italiana, Faculty of Biomedical Sciences Lugano Switzerland.
J Exp Orthop. 2025 Jul 13;12(3):e70355. doi: 10.1002/jeo2.70355. eCollection 2025 Jul.
Several factors can influence progression to total knee arthroplasty (TKA) in knee osteoarthritis (OA) patients. Among these, psychological aspects can play a relevant role. The aim of this study was to quantify the influence of depressive symptoms on the progression to TKA in a large population of patients affected by knee OA.
A total of 912 patients were selected from the Osteoarthritis Initiative (OAI) database. The data collected included demographic data, Kellgren-Lawrence (KL) OA grade, Visual analogue scale (VAS) for pain, Center for Epidemiologic Studies Depression Scale (CES-D) and the number of patients progressing to TKA. Patients with KL 2, 3 or 4 and with symptomatic knee OA (VAS ≥ 3) were included and followed up to 9 years.
At 9 years, 22.9% of patients underwent TKA. Overall, no significant differences of CES-D were found between patients who progressed to TKA and patients who did not. However, in patients with KL grade 2, those who progressed to TKA had a significantly higher CES-D compared to those who did not (6.9 ± 6.6 vs. 5.4 ± 5.2, = 0.018) and the CES-D score significantly associated with the risk of undergoing TKA (hazard ratio = 1.042, = 0.015). The pairwise comparison of KL 2 patients showed a significant difference in terms of progression to TKA between patients having a CES-D > 6 and patients having a CES-D ≤ 6 ( = 0.001). None of these differences were statistically significant in the KL 3 and 4 groups.
This study showed that even minor psychological symptoms related to the depression spectrum, well below the threshold of what commonly considered the level at risk for developing clinical depression, are significantly correlated with the trajectory towards TKA in knee OA patients. However, this correlation was observed only in early KL 2 knee OA patients, but not in the more advanced KL 3 and 4 stages of the disease.
Level III.
多种因素可影响膝关节骨关节炎（OA）患者进展为全膝关节置换术（TKA）。其中，心理因素可能起相关作用。本研究的目的是量化抑郁症状对大量膝关节OA患者进展为TKA的影响。
从骨关节炎倡议（OAI）数据库中选取912例患者。收集的数据包括人口统计学数据、凯尔格伦-劳伦斯（KL）OA分级、疼痛视觉模拟量表（VAS）、流行病学研究中心抑郁量表（CES-D）以及进展为TKA的患者数量。纳入KL 2、3或4级且有症状性膝关节OA（VAS≥3）的患者，并随访9年。
9年后，22.9%的患者接受了TKA。总体而言，进展为TKA的患者与未进展为TKA的患者之间，CES-D无显著差异。然而，在KL 2级患者中，进展为TKA的患者的CES-D显著高于未进展者（6.9±6.6对5.4±5.2，P = 0.018），且CES-D评分与接受TKA的风险显著相关（风险比=1.042，P = 0.015）。KL 2级患者的成对比较显示，CES-D>6的患者与CES-D≤6的患者在进展为TKA方面存在显著差异（P = 0.001）。在KL 3和4级组中，这些差异均无统计学意义。
本研究表明，即使是与抑郁谱系相关的轻微心理症状，远低于通常认为的发生临床抑郁风险水平的阈值，也与膝关节OA患者进展为TKA的轨迹显著相关。然而，这种相关性仅在早期KL 2级膝关节OA患者中观察到，而在疾病更晚期的KL 3和4级阶段未观察到。
三级。
