title: Depression in primary TKA and higher medical comorbidities in revision TKA are associated with suboptimal subjective improvement in knee function.
abstract: BACKGROUND
  To characterize whether medical comorbidities, depression and anxiety predict patient-reported functional improvement after total knee arthroplasty (TKA).
  
  
  METHODS
  We analyzed the prospectively collected data from the Mayo Clinic Total Joint Registry for patients who underwent primary or revision TKA between 1993-2005. Using multivariable-adjusted logistic regression analyses, we examined whether medical comorbidities, depression and anxiety were associated with patient-reported subjective improvement in knee function 2- or 5-years after primary or revision TKA. Odds ratios (OR), along with 95% confidence intervals (CI) and p-value are presented.
  
  
  RESULTS
  We studied 7,139 primary TKAs at 2- and 4,234 at 5-years; and, 1,533 revision TKAs at 2-years and 881 at 5-years. In multivariable-adjusted analyses, we found that depression was associated with significantly lower odds of 0.5 (95% confidence interval [CI]: 0.3 to 0.9; p = 0.02) of 'much better' knee functional status (relative to same or worse status) 2 years after primary TKA. Higher Deyo-Charlson index was significantly associated with lower odds of 0.5 (95% CI: 0.2 to 1.0; p = 0.05) of 'much better' knee functional status after revision TKA for every 5-point increase in score.
  
  
  CONCLUSIONS
  Depression in primary TKA and higher medical comorbidity in revision TKA cohorts were associated with suboptimal improvement in index knee function. It remains to be seen whether strategies focused at optimization of medical comorbidities and depression pre- and peri-operatively may help to improve TKA outcomes. Study limitations include non-response bias and the use of diagnostic codes, which may be associated with under-diagnosis of conditions.
authors.affiliation: Medicine Service and Center for Surgical Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, AL, USA. Jasvinder.md@gmail.coml.
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.forename: David G
authors.initials: DG
authors.lastname: Lewallen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000523:psychology; D001696:Biomechanical Phenomena; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
references.citation: Rheumatology (Oxford). 2013 May;52(5):916-23
references.pmid: 23325037
references.citation: Arthritis Res Ther. 2012 Nov 16;14(6):R248
references.pmid: 23157942
references.citation: J Cardiopulm Rehabil Prev. 2009 Nov-Dec;29(6):358-64
references.pmid: 19940639
references.citation: Semin Arthritis Rheum. 2012 Apr;41(5):689-97
references.pmid: 22055539
references.citation: Mayo Clin Proc. 2010 Oct;85(10):898-904
references.pmid: 20823375
references.citation: J Arthroplasty. 1996 Jan;11(1):47-57
references.pmid: 8676118
references.citation: J Clin Epidemiol. 1992 Jun;45(6):613-9
references.pmid: 1607900
references.citation: J Orthop Sports Phys Ther. 2011 Dec;41(12):932-41
references.pmid: 21979411
references.citation: Arthritis Rheum. 1999 Aug;42(8):1722-8
references.pmid: 10446873
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: BMC Musculoskelet Disord. 2010 May 13;11:90
references.pmid: 20462458
references.citation: Semin Arthritis Rheum. 2012 Feb;41(4):576-88
references.pmid: 22035624
references.citation: J Arthroplasty. 2011 Apr;26(3):366-374.e1
references.pmid: 20413245
references.citation: J Bone Joint Surg Am. 2004 May;86(5):963-74
references.pmid: 15118039
references.citation: Int J Public Health. 2012 Feb;57(1):225-33
references.pmid: 21523617
references.citation: JAMA. 1961 Oct 21;178:261-6
references.pmid: 13887881
references.citation: Health Qual Life Outcomes. 2008 Apr 30;6:31
references.pmid: 18447946
references.citation: J Bone Joint Surg Am. 2007 Jun;89(6):1161-9
references.pmid: 17545417
references.citation: Clin Orthop Relat Res. 2007 Dec;465:185-8
references.pmid: 17906592
references.citation: J Rheumatol. 2002 Jun;29(6):1273-9
references.pmid: 12064846
references.citation: Am J Epidemiol. 1990 May;131(5):905-16
references.pmid: 2321631
references.citation: Arch Orthop Trauma Surg. 2009 Dec;129(12):1585-91
references.pmid: 19198860
references.citation: Arthritis Rheum. 1998 Jun;41(6):1072-82
references.pmid: 9627017
references.citation: Clin Orthop Relat Res. 1989 Nov;(248):13-4
references.pmid: 2805470
references.citation: Med Care. 1992 Jun;30(6):473-83
references.pmid: 1593914
references.citation: Clin Orthop Relat Res. 2003 Nov;(416):208-16
references.pmid: 14646763
references.citation: J Bone Joint Surg Am. 2003 Feb;85(2):259-65
references.pmid: 12571303
references.citation: J Bone Joint Surg Am. 2007 Apr;89(4):780-5
references.pmid: 17403800
references.citation: J Bone Joint Surg Br. 2010 Jun;92(6):799-806
references.pmid: 20513876
references.citation: J Arthroplasty. 2006 Jun;21(4):559-66
references.pmid: 16781410
references.citation: J Cardiopulm Rehabil. 2002 Jan-Feb;22(1):40-6
references.pmid: 11839996
references.citation: Clin Rheumatol. 2009 Dec;28(12):1419-30
references.pmid: 19727914
references.citation: Phys Ther. 2003 Aug;83(8):696-706
references.pmid: 12882610
references.citation: J Bone Joint Surg Am. 2004 Oct;86(10):2179-86
references.pmid: 15466726
references.citation: Clin Orthop Relat Res. 2008 Nov;466(11):2717-23
references.pmid: 18679762
references.citation: Arthritis Rheum. 2004 Feb 15;51(1):100-9
references.pmid: 14872462
references.citation: Clin Orthop Relat Res. 2005 Jun;(435):232-8
references.pmid: 15930944
references.citation: Clin Orthop Relat Res. 1998 Nov;(356):85-92
references.pmid: 9917672
references.citation: J Am Acad Orthop Surg. 2010 Feb;18(2):72-82
references.pmid: 20118324
references.citation: Clin Orthop Relat Res. 2007 Nov;464:21-6
references.pmid: 17603386
references.citation: Am J Public Health. 2013 Aug;103(8):e34-43
references.pmid: 23763394
references.citation: JAMA Ophthalmol. 2013 May;131(5):573-81
references.pmid: 23471505
references.citation: Value Health. 2010 Jun-Jul;13(4):447-54
references.pmid: 20088892
references.citation: Arch Intern Med. 2001 Feb 12;161(3):454-60
references.pmid: 11176772
references.citation: J Chronic Dis. 1987;40(7):705-12
references.pmid: 3110198
references.citation: Ann Rheum Dis. 2011 Oct;70(10):1775-81
references.pmid: 21791452
references.citation: World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253
references.pmid: 11234459
references.citation: Pain. 2011 Oct;152(10):2287-2293
references.pmid: 21764515