The Journal of Arthroplasty, Volume 34, Issue 10, 2337 - 2346

Depression and Anxiety Are Risk Factors for Postoperative Pain-Related Symptoms and Complications in Patients Undergoing Primary Total Knee Arthroplasty in the United States

Pan, Xin et al.


The study was designed to analyze the underlying relationship between psychiatric comorbidities and postoperative outcomes in patients undergoing primary total knee arthroplasty (TKA).


We used the National Inpatient Sample data from 2002 to 2014. On the basis of the International Classification of Disease, Ninth Revision, Clinical Modification, we divided TKA patients into 4 subgroups: those diagnosed with depression, those diagnosed with anxiety, those concomitantly diagnosed with both depression and anxiety, and those without depression or anxiety. The chi-squared test and analysis of variance were performed to measure differences among these 4 subgroups. Multiple logistic regression analysis was used to determine whether psychological comorbidities were independent risk factors for postoperative complications and surgery-related pain.


A total of 7,153,750 patients in the United States were estimated to have undergone TKA between 2002 and 2014. The prevalence of depression, anxiety, or both diagnoses in TKA patients significantly increased over time. Patients with psychiatric disorders showed higher hospital costs but shorter periods of hospitalization, with higher odds ratios for most complications and all pain-related symptoms observed in this study.


The prevalence of depression and anxiety in TKA patients is increasing steadily each year. Psychiatric disorders were closely correlated with the outcomes of TKA. The mental health of patients undergoing TKA needs more attention to ensure adequate relief from postoperative pain-related symptoms as well as quality of life.

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