title: Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study.
abstract: BACKGROUND
  A subset of patients with total hip arthroplasty (THA) or total knee arthroplasty (TKA) has suboptimal postoperative results in terms of Patient Reported Outcomes (PROs), and psychological factors could contribute to these suboptimal results.
  
  
  OBJECTIVE
  To examine the prevalence of anxiety and depressive symptoms in patients undergoing primary THA or TKA preoperatively and postoperatively, and the relationship between preoperative anxiety and depressive symptoms on PROs of THA and TKA.
  
  
  METHODS
  In this prospective study patients were measured preoperatively, and 3 and 12 months postoperatively. Patients filled in the Hospital Anxiety and Depression Scale, Knee injury and Osteoarthritis Outcome Score (KOOS) or Hip disability and Osteoarthritis Outcome Score (HOOS) and a satisfaction questionnaire.
  
  
  RESULTS
  Data were obtained from 149 hip and 133 knee patients. The prevalence of anxiety symptoms decreased significantly from 27.9% to 10.8% 12 months postoperatively in hip patients, and from 20.3% to 14.8% in knee patients. Depressive symptoms decreased significantly from 33.6% to 12.1% 12 months postoperatively in hip patients, and from 22.7% to 11.7% in knee patients. In hip and knee patients, preoperative depressive symptoms predicted smaller changes in different HOOS or KOOS subscales and patients were less satisfied 12 months postoperatively.
  
  
  CONCLUSIONS
  Preoperatively, the prevalence of anxiety and depressive symptoms was high. At 3 and 12 months postoperatively, the prevalence of anxiety and depressive symptoms was decreased in both hip and knee patients. However, patients with preoperative anxiety and depressive symptoms had worse PROs 3 and 12 months after THA and TKA and were less satisfied than patients without anxiety or depressive symptoms.
authors.affiliation: Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands. Electronic address: t.duivenvoorden@erasmusmc.nl.
authors.forename: T
authors.initials: T
authors.lastname: Duivenvoorden
authors.forename: M M
authors.initials: MM
authors.lastname: Vissers
authors.forename: J A N
authors.initials: JA
authors.lastname: Verhaar
authors.forename: J J V
authors.initials: JJ
authors.lastname: Busschbach
authors.forename: T
authors.initials: T
authors.lastname: Gosens
authors.forename: R M
authors.initials: RM
authors.lastname: Bloem
authors.forename: S M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
authors.forename: M
authors.initials: M
authors.lastname: Reijman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology*; D019644:Arthroplasty, Replacement, Hip / Q000523:psychology*; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000523:psychology* / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000523:psychology* / Q000601:surgery; D017060:Patient Satisfaction; D015995:Prevalence; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Anxiety disorder; Arthroplasty; Depressive disorder; Patient reported outcome; Patient satisfaction