Published online Mar 19, 2026. doi: 10.5498/wjp.v16.i3.113625
Revised: October 29, 2025
Accepted: December 12, 2025
Published online: March 19, 2026
Processing time: 151 Days and 23.7 Hours
Total knee arthroplasty (TKA) is an effective treatment for end-stage knee joint disease, but postoperative functional recovery outcomes vary significantly among patients. In recent years, researchers have increasingly focused on the influence of psychological factors on surgical outcomes, yet studies on the impact of pre
To investigate the effects of preoperative anxiety levels on functional recovery outcomes following TKA, providing a more comprehensive treatment strategy for clinical practice.
A retrospective cohort study design was employed to collect clinical data from 186 patients who underwent TKA at a tertiary hospital between January 2020 and December 2023. Patients were divided into a study group (86 cases) and a control group (100 cases) based on preoperative anxiety status. The Hamilton Anxiety Scale and Hamilton Depression Scale were used to assess patients’ mental status. Postoperative rehabilitation time, joint function scores, complication rates, and other indicators were compared between the two groups. Multivariate logistic regression analysis was conducted to determine independent risk factors affecting functional recovery.
Compared to the control group, the study group showed significantly longer postoperative hospital stays [(14.3 ± 3.7) days vs (10.6 ± 2.4) days, P < 0.01], lower knee function scores at 3 months postoperatively [(68.2 ± 8.5) vs (79.9 ± 7.3), P < 0.05], and higher complication rates (32.3% vs 17.2%, P < 0.05). Multivariate analysis identified high preoperative anxiety levels [odds ratio (OR) = 2.47, 95% confidence interval (CI): 1.82-3.36], chronic stress (OR = 1.94, 95%CI: 1.43-2.65), and lack of social support (OR = 1.76, 95%CI: 1.21-2.54) as independent risk factors affecting postoperative functional recovery. Analysis of neuroendocrine and immune indicators revealed elevated stress hormone levels and abnormal expression of inflammatory factors in the study group, which may represent important mechanisms through which anxiety affects postoperative rehabilitation.
Preoperative anxiety is a significant factor influencing functional recovery following TKA. It interferes with the rehabilitation process through multiple pathways, including impacts on patients' self-care behaviors, sleep quality, endocrine function, and immune responses.
Core Tip: This study highlights the significant role of preoperative anxiety in determining functional recovery after total knee arthroplasty. Patients with elevated anxiety levels experienced longer hospital stays, poorer knee function, and higher complication rates. Mechanistic analyses revealed dysregulated neuroendocrine stress responses, increased pro-inflammatory cytokines, impaired treatment adherence, and sleep disturbances as mediating pathways. These findings underscore preoperative anxiety as a modifiable risk factor and emphasize the importance of integrating psychological assessment and targeted interventions into perioperative care. A multidisciplinary approach addressing both mental health and physical rehabilitation may optimize recovery outcomes.