title: The presence and influence of mild depressive symptoms on post-operative pain perception following primary total knee arthroplasty.
abstract: OBJECTIVE
  To evaluate the influence of mild depression on pain perception after total knee arthroplasty (TKA).
  
  
  METHODS
  Hamilton depression (HDRS) and numeric rating (NRS) scales were used to evaluate depression severity and pain perception at various intervals surrounding TKA. The Hospital for Special Surgery (HSS) knee and pain scores (NRS) in patients with signs of mild depression (HDRS < 20 points) were compared to a control group of patients with no signs of depression (HDRS < 8 points).
  
  
  RESULTS
  Prior to surgery, there were no statistical differences in pain perception (NRS) or individual components of HSS knee score including range of motion, pain, and function between patients with mild depression compared to controls. However, following surgery, patients with signs of mild depression were more likely to report more pain (p < 0.001) and have lower HSS scores even at 1 year post-operatively (p < 0.001).
  
  
  CONCLUSIONS
  A significant number of patients in this series undergoing routine primary TKA had signs of subclinical depression. These patients are more likely to report increased pain even at 1 year following surgery compared to patients without signs of depression preoperatively. Psychometric evaluation prior to surgery can help identify the at-risk patient and allow for proper management of patient expectations, thus improving clinical results and patients' satisfaction after TKA.
  
  
  METHODS
  Prospective comparative study, II.
authors.affiliation: AO Città della Salute e della Scienza, Department of Orthopedics, Traumatology and Rehabilitative Medicine, CTO Hospital, Via Zuretti 29, 10126, Turin, Italy. abistolfi@cittadellasalute.to.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bistolfi
authors.affiliation: School of Rehabilitative Medicine, University of the Studies of Turin, Via Zuretti 29, 10126, Turin, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Bettoni
authors.affiliation: Orthopaedic Department, San Luigi Hospital of Orbassano, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Aprato
authors.affiliation: School of Rehabilitative Medicine, University of the Studies of Turin, Via Zuretti 29, 10126, Turin, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Milani
authors.affiliation: Department of clinical and biological sciences, Statistics, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Berchialla
authors.affiliation: AO Città della Salute e della Scienza, Department of Orthopedics, Traumatology and Rehabilitative Medicine, CTO Hospital, Via Zuretti 29, 10126, Turin, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Graziano
authors.affiliation: AO Città della Salute e della Scienza, Department of Orthopedics, Traumatology and Rehabilitative Medicine, CTO Hospital, Via Zuretti 29, 10126, Turin, Italy.|School of Rehabilitative Medicine, University of the Studies of Turin, Via Zuretti 29, 10126, Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Massazza
authors.affiliation: Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Pennsylvania Hospital, 1 Cupp Pavilion, 51 N 39th Street, Philadelphia, PA, 19104, USA.
authors.forename: Gwo Chin
authors.initials: GC
authors.lastname: Lee
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D016022:Case-Control Studies; D003863:Depression / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058748:Pain Perception; D010149:Postoperative Pain / Q000175:diagnosis / Q000523:psychology*; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales
keywords: Depression; Pain; Results; Total knee arthroplasty