Background/Purpose: While anxiety and depression are highly prevalent in persons with symptomatic knee osteoarthritis (OA), few studies have assessed the effect of treatment of knee OA on these mood disorders. Further, it remains unclear which individuals will continue to have persistent anxiety and/or depression after OA treatment, limiting targeted intervention. Thus, the objectives of this study were to, in individuals with knee OA undergoing primary total knee arthroplasty (TKA): (1) describe the proportion of patients who report being anxious or depressed (A/D) pre TKA, 6 months post TKA, and 12 months post TKA; and (2) determine, in those with self-reported A/D pre TKA, the factors associated with persistence of mood disorder at 12 months post TKA.

Methods: In this prospective cohort study, patients with knee OA were assessed one month pre- and 6 and 12 months post-TKA. Questionnaires assessed sociodemographic factors, knee OA symptoms, comorbidities, and psychosocial factors. We assessed prevalence of self-reported A/D using the Anxiety/Depression dimension of the EQ-5D-3L. Self-reported A/D was defined as reporting being moderately or extremely anxious or depressed. Among individuals with self-reported A/D pre TKA, multivariable Poisson regression with a robust error variance was used to assess the association of sociodemographic factors, comorbidities, psychosocial factors, and knee OA symptoms with persistence of self-reported A/D at 12 months post TKA.

Results: 1259 patients were included: mean age 67.2 years, 60.8% female, mean pre TKA WOMAC pain 57.6 (SD 17.4) /100, and mean pre TKA KOOS-PS physical function 53.3 (SD 17.3)/100 (higher scores worse). The mean change from pre TKA to 12 months post TKA in WOMAC pain was -42.7 (SD 21.9), and in KOOS-PS was -29.6 (SD 21.5). Prevalence of self-reported A/D pre TKA was 624 (49.6%), at 6 months was 278 (22.1%), and at 12 months was 254 (20.2%). Of the 624 participants with self-reported A/D pre TKA, 197 (31.6%) self-reported A/D 12 months post TKA. In multivariable regression, persistence of A/D at 12 months post TKA was associated with reporting higher levels of knee OA pain post TKA (RR per WOMAC unit 1.02, 95% CI 1.01 to 1.03), greater knee OA functional impairment post TKA (RR per KOOS-PS unit 1.01, 95% CI 1.00 to 1.03), less pre TKA self-efficacy (RR per unit General Self-Efficacy Scale 0.97, 95% CI 0.94 to 0.99), and the presence of a pre TKA depression diagnosis (RR 1.89, 95% CI 1.44 to 2.48). Analyses stratified by sex, age (< 60/≥60 years), obesity, and reporting a prior diagnosis of depression were not appreciably different from the primary model.

Conclusion: A large proportion of individuals with knee OA report being anxious or depressed pre TKA. Of these individuals, greater than two-thirds report resolution of their mood disorder by 12 months post TKA. We found a higher risk of persistence in individuals with worse knee OA symptoms post TKA and among those with less self-efficacy. However, the strongest factor associated with persistence of A/D was a previous diagnosis of depression suggesting a group of individuals whose depression may not be related to their OA and would benefit from targeted mental health interventions to improve mood outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/decrease-in-prevalence-of-self-reported-anxiety-or-depression-in-persons-with-osteoarthritis-after-total-knee-arthroplasty-the-best-knee-cohort-study/