Nicolino Tomas Ignacio, Smietniansky Maximiliano, Boietti Bruno, Garcia-Mansilla Ignacio, Carbo Lisandro, Martinez Cintia Belen
Division of Knee, Department of Orthopaedics, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina.
Program for Determination and Management of Risks for Practices and Procedures and Preoperative Evaluation, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina.
World J Methodol. 2025 Dec 20;15(4):102758. doi: 10.5662/wjm.v15.i4.102758.
The prevalence of depressive symptoms in patients undergoing total knee arthroplasty (TKA) ranges from 22% to 26%. The impact of depression on functional status post-TKA remains controversial.
To be the first study in Latin American population to evaluate the association between depression and functional status one year after TKA, hypothesizing that elderly patients with depression will demonstrate lower rates of functional improvement.
We conducted an observational, descriptive and analytic, retrospective cohort study involving patients over 65 years old who were indicated for TKA. Assessments were made the Program for Determination and Management of Risks for Practices and Procedures of the Division of Geriatric Medicine at the Italian Hospital of Buenos Aires, between June 2015 and July 2019. Depression screening was conducted using Yesavage's abbreviated score and Patient Health Questionnaire-9, while functional ability was evaluated using the Knee Society Score (KSS).
Of the 100 patients analyzed, 22 (22%) screened positive for depression. The mean age was 80 years ± 6.3 years, with an average of 77.6 years ± 6 years in the depressed group and 80.6 years ± 6.3 years in the non-depressed group ( = 0.05). Depressed patients showed significantly greater cognitive impairment [clock-face drawing test median: 5 (3-6) 6 (5-7), = 0.06] and more risk factors for confusional syndrome (mean: 8 ± 2 6.5 ± 2.2, = 0.006). Frailty was also more prevalent in depressed patients [Edmonton: 15 (68%) 33 (42%), = 0.05; Fried: 17 (77%) 42 (54%), = 0.05]. Postoperative Functional KSS were similar between groups (depressed: 65 ± 22.1 non-depressed: 66.3 ± 20.3, = 0.8). Linear regression analysis revealed no association between depression and changes in KSS. Spearman's rank correlation coefficients were -0.0304 ( = 0.8) for Functional KSS variation and -0.1 ( = 0.3) for KSS variation.
Depression in patients with osteoarthritis should not hinder surgical planning. Identifying and treating depression preoperatively may enhance outcomes such as pain relief and reduce risks of acute confusional syndrome, cognitive impairment, and frailty.
接受全膝关节置换术（TKA）的患者中，抑郁症状的患病率在22%至26%之间。抑郁对TKA术后功能状态的影响仍存在争议。
成为拉丁美洲人群中第一项评估TKA术后一年抑郁与功能状态之间关联的研究，假设患有抑郁症的老年患者功能改善率较低。
我们进行了一项观察性、描述性和分析性的回顾性队列研究，纳入了65岁以上接受TKA手术的患者。评估由布宜诺斯艾利斯意大利医院老年医学科实践与程序风险确定和管理项目于2015年6月至2019年7月期间进行。使用耶萨维奇简易评分法和患者健康问卷-9进行抑郁筛查，同时使用膝关节协会评分（KSS）评估功能能力。
在分析的100例患者中，22例（22%）抑郁筛查呈阳性。平均年龄为80岁±6.3岁，抑郁组平均年龄为77.6岁±6岁，非抑郁组为80.6岁±6.3岁（P = 0.05）。抑郁患者表现出明显更严重的认知障碍[钟面绘图测试中位数：5（3 - 6）对6（5 - 7），P = 0.06]以及更多的谵妄综合征风险因素（平均值：8±2对6.5±2.2，P = 0.006）。衰弱在抑郁患者中也更为普遍[埃德蒙顿：15例（68%）对33例（42%），P = 0.05；弗里德：17例（77%）对42例（54%），P = 0.05]。两组术后功能KSS相似（抑郁组：65±22.1对非抑郁组：66.3±20.3，P = 0.8）。线性回归分析显示抑郁与KSS变化之间无关联。功能KSS变化的斯皮尔曼等级相关系数为 -0.0304（P = 0.8），KSS变化的为 -0.1（P = 0.3）。
骨关节炎患者的抑郁不应妨碍手术规划。术前识别和治疗抑郁可能会改善诸如疼痛缓解等结果，并降低急性谵妄综合征、认知障碍和衰弱的风险。
