Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 11, pp 3411–3416 | Cite as

Depressed patients feel more pain in the short term after total knee arthroplasty

  • Raúl Torres-Claramunt
  • Pedro Hinarejos
  • Jorge Amestoy
  • Joan Leal
  • Juan Sánchez-Soler
  • Lluís Puig-Verdié
  • Joan C. Monllau
KNEE
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Accepted:

Abstract

Purpose

The hypothesis of this study was that depressive patients feel more pain in the immediate TKA postoperative period in comparison with non-depressed patients.

Methods

The diagnosis of depression was made with the Geriatric Depression Scale Short Form. The Visual Analogic Score (VAS) was registered each 8 h during the first 3 days. The mean and maximum VAS and the number of analgesic rescues required in this period were calculated in 803 consecutive TKAs. The Knee Society Score (KSS), the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36) scores were obtained preoperatively and at the 1-year follow-up.

Results

Forty-eight (6%) of these patients were considered depressed. The results obtained in the depressed patients and non-depressed were, respectively, mean VAS (2.0 vs 1.0, p = 0.00), maximum VAS (5.3 vs 1.6, p = 0.00), and number of rescues needed (4.4 vs 1.8, p = 0.00). Although depressed patients scored worse in the functional and quality of life scores in the preoperative period, the improvement obtained (1-year outcomes minus preoperative outcomes) in the different scores was similar in both groups with the exception of the mental domain of the SF-36, which improved further in depressed patients (p = 0.00).

Conclusion

Depressed patients feel more pain in the immediate postoperative period. However, the improvement obtained in functional and referred quality of life scores is similar to non-depressed patients.

Level of evidence

II.

Keywords

Depression TKA Arthroplasty SF-36 KSS Knee Yesavage Outcomes 
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Notes

Compliance with ethical standards

Conflict of interest

None.

Disclosure of funding

None.

References

  1. 1.
    Alonso J, Prieto L, Antó JM (1995) The Spanish version of the SF-36 Health Survey (the SF-36 health questionnaire): an instrument for measuring clinical results. Med Clin (Barc) 104(20):771–776Google Scholar
  2. 2.
    Alonso J, Regidor E, Barrio G, Prieto L, Rodriguez C, de la Fuente L (1998) Population reference values of the Spanish version of the Health Questionnaire SF-36. Med Clin (Barc) 111(11):410–416Google Scholar
  3. 3.
    Ares O, Castellet E, Maculé F, León V, Montañez E, Freire A, Hinarejos P, Montserrat F, Amillo JR (2013) Translation and validation of “The Knee Society Clinical Rating System” into Spanish. Knee Surg Sports Traumatol Arthorsc. 21(11):2618–2624CrossRefGoogle Scholar
  4. 4.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of the WOMAC: a health status instrument for measuring clinically important patients-relevant outcomes following total hip or knee arthroplasty in osteoarthritis. J Orthop Rheumatol 1:95–108Google Scholar
  5. 5.
    Bistolfi A, Bettoni E, Aprato A, Milani P, Berchialla P, Graziano E, Massazza G, Lee GC (2015) The presence and influence of mild depressive symptoms on postoperative pain perception following primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-015-3737-y PubMedGoogle Scholar
  6. 6.
    Escobar A, Quintana JM, Bilbao A, Azkárate J, Güenaga JI (2002) Validation of the Spanish version of the WOMAC questionnaire for patients with hip or knee ostehoarthritis. Clin Rheumatol 21(6):466–471CrossRefPubMedGoogle Scholar
  7. 7.
    Eymard F, Charles-Nelson A, Katsahian S, Chevalier X, Bercovy M (2016) Predictive factors of “Forgotten Knee” acquisition after total knee arthroplasty: long-term follow-up of a large prospective cohort. J Arthroplasty. doi: 10.1016/j.arth.2016.06.020 PubMedGoogle Scholar
  8. 8.
    Filardo G, Merli G, Roffi A, Marcacci T, Barti Ceroni F, Raboni D, Bortolotti B, Kon E, Marcacci M (2016) Kinesophobia and depression affect total knee arthroplasty outcome in a multivariate analysis of psychological and physical factors on 200 patients. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-016-4201-3 Google Scholar
  9. 9.
    Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W (2013) Pain intensisty on the first fay after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 118(4):934–944CrossRefPubMedGoogle Scholar
  10. 10.
    Giesinger K, Hamilton DF, Jost B, Holzner B, Giesinger JM (2014) Comparative responsiveness of outcome measures for total knee arthroplasty. Osteoarthritis Cartilage 22(2):184–189CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Gold HT, Slover JD, Joo L, Bosco J, Iorio R, Oh C (2016) Association of depression with 90-day hospital readmission after total knee joint arthroplasty. J Arthroplasty. doi: 10.1016/j.arth.2016.04.010 Google Scholar
  12. 12.
    Gong L, Chen H (2014) Descripitve analysis of the cost-effectiveness of depressed patients undergoing total knee arthroplasty: an economic decision analysis. J Orthop Sci 19(5):820–826CrossRefPubMedGoogle Scholar
  13. 13.
    Grosu I, Lavand´homme P, Thienpont E (2014) Pain after knee arthroplasty: an unresolved issue. Knee Surg Sports Traumatol Arthorsc 22(8):1744–1758CrossRefGoogle Scholar
  14. 14.
    Hirschmann MT, Iranpour F, Konala P, Kerner A, Rasch H, Cobb JP, Friederich NF (2010) A novel standardized algorithm for evaluating patients with painful total knee arthroplasty using combined single photon emission tomography and conventional computerized tomography. Knee Surg Sports Traumatol Arthrosc 18(7):939–944CrossRefPubMedGoogle Scholar
  15. 15.
    Hirschmann MT, Testa E, Amsler F, Friederich NF (2013) The unhappy total knee arthroplasty (TKA) patient: higher WOMAC and lower KSS in depressed patients prior and after TKA. Knee Surg Sports Traumatol Arthrosc 21(10):2405–2411CrossRefPubMedGoogle Scholar
  16. 16.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14Google Scholar
  17. 17.
    Keats AS (1978) The ASA classification of physical status—a recapitulation. Anesthesiology 49(4):233–236CrossRefPubMedGoogle Scholar
  18. 18.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revisions hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785PubMedGoogle Scholar
  19. 19.
    Lavernia CJ, Villa JM, Iacobelli DA (2015) What is the role of mental health in primary total knee arthroplasty? Clin Orthop Relat Res 473(1):159–163CrossRefPubMedGoogle Scholar
  20. 20.
    Lesher EL, Berryhill JS (1994) Validation of the geriatric depression scale-short form among in patients. J Clin Psychol 50(2):256–260CrossRefPubMedGoogle Scholar
  21. 21.
    Lewis GN, Rice DA, McNair PJ, Kluger M (2015) Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 114(4):551–561CrossRefPubMedGoogle Scholar
  22. 22.
    Naal FD, Impellizzeri FM, Lenze U, Wellauer V, von Eisenhart-Rothe R, Leunig M (2015) Clinical improvement and satisfaction after total joint replacement: a prospective 12-month evaluation on the patients´ perspective. Qual Life Res 24:2917–2925CrossRefPubMedGoogle Scholar
  23. 23.
    Ortega R, Salinero MA, Kazemzadeh A, Vidal S, de Dios R (2007) Validation of 5 and 15 items Spanish version of the geriatric depression scale in elderly subjects in primary health care setting. Rev Clin Esp 207(11):559–562CrossRefGoogle Scholar
  24. 24.
    Pérez-Prieto D, Gil-González S, Pelfort X, Leal-Blanquet J, Puig-Verdié L, Hinarejos P (2014) Influence of depression on total knee arthroplasty outcomes. J Arthroplasty 29(1):44–47CrossRefPubMedGoogle Scholar
  25. 25.
    Riddle DL, Perera RA, Nay WT, Dumenci L (2015) What Is the Relationship between depressive symptoms and pain during functional tasks in persons undergoing TKA? A 6-year perioperative cohort study. Clin Orthop Relat Res 473(11):3527–3534CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Sheikh JI, Yesavage JA (1986) Geriatric Depression Scale (GDS). Recent evidence and development of a shorter version. In: Brink TL (ed) Clinical gerontology: a guide to assessment and intervention. The Haworth Press, Inc, NY, pp 165–173Google Scholar
  27. 27.
    Toms AD, Mandalia V, Haigh R, Hopwood B (2009) The management of patients with painful total knee replacement. J Bone Joint Surg Br 91(2):143–150CrossRefPubMedGoogle Scholar
  28. 28.
    Utrillas-Compaired A, De la Torre-Escuredo BJ, Tebar-Martínez AJ, Asúnsolo-Del Barco Á (2014) Does preoperative psychologic distress influence pain, function, and quality of life after TKA? Clin Orthop Relat Res 472(8):2457–2465PubMedPubMedCentralGoogle Scholar
  29. 29.
    Vissers MM, Bussmann JB, Verhaar JA, Busschbach JJ, Bierma-Zeinstra SM, Reijman M (2012) Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review. Semin Arthritis Rheumat 41(4):576–588CrossRefGoogle Scholar
  30. 30.
    Ware JE, Sherbourne CD (1992) The MOS 36-item Short-Form Health Survey (SF-36): I. conceptual framework and item selection. Med Care 30(6):473–483CrossRefPubMedGoogle Scholar
  31. 31.
    Wylde V, Hewlett S, Learmonth ID, Dieppe P (2011) Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain 152(3):566–572CrossRefPubMedGoogle Scholar
  32. 32.
    Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO (1982–1983) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17(1):37–49Google Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Raúl Torres-Claramunt
    • 1
    • 2
  • Pedro Hinarejos
    • 1
    • 2
  • Jorge Amestoy
    • 1
  • Joan Leal
    • 1
  • Juan Sánchez-Soler
    • 1
  • Lluís Puig-Verdié
    • 1
    • 2
  • Joan C. Monllau
    • 1
    • 2
  1. 1.Orthopaedic Department, Hospital del MarUniversitat Autònoma BarcelonaBarcelonaSpain
  2. 2.IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain

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