Author(s): VELDSMAN, T., BROADBENT, S., MOSS, S.J., Institution: NORTH-WEST UNIVERSITY, Country: SOUTH AFRICA, Abstract-ID: 2568

INTRODUCTION:
Patients undergoing total knee replacement (TKR) report pain and experience pre-operative anxiety and depression, which affects their quality of life. Limited information is available on changes in these variables within the first six weeks postoperatively. The primary purpose of the study is to determine the relationship between anxiety and depression, and the Knee Injury Osteoarthritis Outcome score (KOOS) of patients 10 days and six weeks after TKR surgery.
METHODS:
Participants (n=46) aged 59.61±9.23 years completed the Hospital Anxiety and Depression scale (HADS) and the KOOS surveys at 10 days and 6 weeks after an elective TKR surgery. All surgeries were performed by the same orthopedic surgeon. Spearman's rank correlation between the HADS and the KOOS was performed using SPSS v. 31. The level of significance was set at p≤0.05.
RESULTS:
Participants at 10 days postoperative, reported an average HADS-anxiety of 4.43±4.47 and a depression score of 4.98±4.58, respectively. Although the total scores were considered average, 15.2% of participants reported high anxiety and 4.3% borderline, while 19.3% reported above normal scores for depression and 4.3% borderline. In the 6-week follow-up data, participants’ depressive scores decreased significantly (10 days:5 and 6 weeks:3), and QoL increased from 55 to 78 (p≤0.001). The relationship between the HADS and the KOOS revealed a significant negative relationship between anxiety and pain (r=-0.323; p=0.029), and activities of daily living (ADL) (r=-0.374; p=0.011), while depression revealed a significant negative relationship with ADL (r=-0.305; p=0.039). At 6 weeks post TKR, anxiety was negatively associated with pain (r=-0.45; p=0.006) and ADL (r=-0.378; p=0.023). However, depressive symptoms were negatively related with pain (r=-0.559; p<0.001); ADL (r=-0.528; p≤0.001); sport and recreation (r=-0.469; p=024) and QoL (r=-0.440; r=0.009).
CONCLUSION:
A small but meaningful proportion of participants experienced elevated anxiety and depression 10 days after TKR surgery, and these emotional symptoms could be explained by pain and reduced ADL outcomes. Psychological distress—particularly depression—was consistently associated with worse pain, reduced functional ability, and lower knee-related quality of life, with these relationships strengthening over the first six weeks of recovery. Early postoperative psychological screening may therefore be important for managing mental health for optimal recovery. Identifying and addressing anxiety and depressive symptoms soon after a TKR procedure may support functional outcomes and enhance the overall rehabilitation process.