Original Article

Impact of Depressive Symptomology on Pain and Function during Recovery after Total Joint Arthroplasty

Authors: Lauren A. Beaupre, PT, PhD, Sung H. Kang, MSc, Gian S. Jhangri, MSc, Tyson Boettcher, MD, C. Allyson Jones, PT, PhD

Abstract

Objectives: To determine the effect of preoperative depressive symptoms on patient-reported function and pain following total joint arthroplasty (TJA) after controlling for potential confounding factors; how depressive symptoms changed after TJA; and the impact of postoperative depressive symptoms on recovery.

Methods: A prospective cohort study undertaken in a metropolitan region in Canada enrolled 710 participants; 622 (87%) had complete 6-month data. Participants completed standardized measures preoperatively and at 1, 3, and 6 months postoperatively. The primary outcome was Western Ontario McMaster Osteoarthritis Index (WOMAC) pain and function. Three groups were created: depressive symptoms absent (n = 573, 82%), possible depressive symptoms (n = 58, 8%), and probable depressive symptoms (n = 68, 10%) using the Center for Epidemiologic Scale for Depression score. Risk-adjusted analyses examined the association between WOMAC change and the preoperative Center for Epidemiologic Scale for Depression score.

Results: After risk adjustment, preoperative possible and probable depressive symptomology was associated with postoperative WOMAC pain scores that were 7.6 and 11.7 points, respectively, worse and WOMAC function scores that were 8.8 and 14.3 points, respectively, worse than those without preoperative depressive symptoms. Depressive symptoms improved postoperatively; by 6 months post-TJA, only 34 (5%) participants screened as having probable depressive symptoms, whereas only 13(2%) had possible depressive symptoms. Postoperative WOMAC pain and function scores improved, but they were negatively affected by possible and probable depressive symptoms.

Conclusions: Although depressive symptoms improve postoperatively, preoperative depressive symptoms, especially for those with probable depressive symptomology, may negatively affect postoperative pain and functional recovery even after risk adjustment.
Posted in: Mental Health38

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Canadian Institute of Health Information. Hip and Knee Replacements in Canada, 2016-2017: Canadian Joint Replacement Registry Annual Report. https://secure.cihi.ca/free_products/cjrr-annual-report-2018-en.pdf. Accessed April 22, 2019.
 
2. Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89:780–785.
 
3. Jones CA, Voaklander DC, Johnston DW, et al. Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. J Rheumatol 2000;27:1745–1752.
 
4. Ponnusamy KE, Vasarhelyi EM, Somerville L, et al. Cost-effectiveness of total knee arthroplasty vs nonoperative management in normal, overweight, obese, severely obese, morbidly obese, and super-obese patients: a Markov model. J Arthroplasty 2018;33:S32–S38.
 
5. Ponnusamy KE, Vasarhelyi EM, McCalden RW, et al. Cost-effectiveness of total hip arthroplasty versus nonoperative management in normal, overweight, obese, severely obese, morbidly obese, and super obese patients: a Markov model. J Arthroplasty 2018;33:3629–3636.
 
6. Schilling CG, Dowsey MM, Petrie DJ, et al. Predicting the long-term gains in health-related quality of life after total knee arthroplasty. J Arthroplasty 2017;32:395–401.
 
7. Beswick AD, Wylde V, Gooberman-Hill R, et al. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2012;2:e000435.
 
8. Kim DH, Pearson-Chauhan KM, McCarthy RJ, et al. Predictive factors for developing chronic pain after total knee arthroplasty. J Arthroplasty 2018;33:3372–3378.
 
9. Pinto PR, McIntyre T, Ferrero R, et al. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact. J Pain Res 2013;6:691–703.
 
10. Lewis GN, Rice DA, McNair PJ, et al. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 2015;114:551–561.
 
11. Sorel JC, Veltman ES, Honig A, et al. The influence of preoperative psychological distress on pain and function after total knee arthroplasty: a systematic review and meta-analysis. Bone Joint J 2019;101B:7–14.
 
12. Vissers MM, Bussmann JB, Verhaar JA, et al. Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review. Semin Arthritis Rheum 2012;41:576–588.
 
13. Wylde V, Dennis J, Gooberman-Hill R, et al. Effectiveness of postdischarge interventions for reducing the severity of chronic pain after total knee replacement: systematic review of randomised controlled trials. BMJ Open 2018;8:e020368.
 
14. Visser MA, Howard KJ, Ellis HB. The influence of major depressive disorder at both the preoperative and postoperative evaluations for total knee arthroplasty outcomes. Pain Med 2019;20:826–833.
 
15. Scott JE, Mathias JL, Kneebone AC. Depression and anxiety after total joint replacement among older adults: a meta-analysis. Aging Mental Health 2016;20:1243–1254.
 
16. Bletterman AN, de Geest-Vrolijk ME, Vriezekolk JE, et al. Preoperative psychosocial factors predicting patient's functional recovery after total knee or total hip arthroplasty: a systematic review. Clin Rehabil 2018;32:512–525.
 
17. Bellamy N., Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically-important patient-relevant outcomes following total hip or knee arthoplasty in osteoarthritis. J Orthop Rheumatol 1988;1:95–108.
 
18. Bombardier C, Melfi CA, Paul J, et al. Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery. Med Care 1995;33:AS131–AS144.
 
19. Hawker GA, Wright JG, Coyte PC, et al. Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med 2000;342:1016–1022.
 
20. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psycholog Measurement 1977;385–401.
 
21. Hann D, Winter K, Jacobsen P. Measurement of depressive symptoms in cancer patients: evaluation of the Center for Epidemiological Studies Depression Scale (CES-D). J Psychosom Res 1999;437–443.
 
22. Himmelfarb S, Murrell SA. Reliability and validity of five mental health scales in older persons. J Gerontol 1983;38:333–339.
 
23. Radloff LS, Teri L. Use of the Center for Epidemiological Studies-Depression Scale with older adults. Clin Gerontol 1986;5:119–136.
 
24. Shean G, Baldwin G. Sensitivity and specificity of depression questionnaires in a college-age sample. J Genet Psychol 2008;169:281–288.
 
25. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med 1991;32:705–714.
 
26. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.
 
27. Voaklander DC, Kelly KD, Jones CA, et al. Self report co-morbidity and health related quality of life – a comparison with record based comorbidity measures. Soc Indicator Res 2004;66:213–228.
 
28. Jones CA, Voaklander DC, Johnston WC, et al. The effect of age on pain, function, and quality of life after total hip and knee arthroplasty. Arch Int Med 2001;161:454–460.
 
29. Harmelink KEM, Zeegers AVCM, Hullegie W, et al. Are there prognostic factors for one-year outcome after total knee arthroplasty? A systematic review. J Arthroplasty 2017;32:3840–3853.
 
30. Riddle DL, Perera RA, Nay WT, et al. What is the relationship between depressive symptoms and pain during functional tasks in persons undergoing TKA? A 6-year perioperative cohort study. Clin Orthop 2015;473:3527–3534.
 
31. Kennedy DM, Stratford PW, Riddle DL, et al. Assessing recovery and establishing prognosis following total knee arthroplasty. Phys Ther 2008;88:22–32.