Preoperative anxiety and psychological determinants of functional recovery after total knee arthroplasty: A retrospective cohort study

Table 1 Baseline characteristics of patients undergoing total knee arthroplasty, n (%)

Characteristics	Study group (n = 86)	Control group (n = 100)	P value
Demographic characteristics
Age (years), mean ± SD	68.4 ± 12.5	65.9 ± 13.1	0.183
Gender			0.642
Male	49 (57.0)	54 (54.0)
Female	37 (43.0)	46 (46.0)
BMI (kg/m2)	23.5 ± 4.1	24.1 ± 3.8	0.305
Clinical characteristics
Duration of knee symptoms (months)	7.8 ± 2.3	6.2 ± 1.8	0.028
Kellgren-Lawrence grade			0.731
Grade III	51 (59.3)	63 (63.0)
Grade IV	35 (40.7)	37 (37.0)
Preoperative knee ROM (degrees)	88.5 ± 15.6	95.2 ± 14.3	0.136
Knee pain location			0.840
Medial	45 (52.3)	55 (55.0)
Lateral	19 (22.1)	20 (20.0)
Anterior	14 (16.3)	17 (17.0)
Diffuse	8 (9.3)	8 (8.0)
Comorbidities
Diabetes	32 (37.2)	33 (33.0)	0.641
Hypertension	43 (50.0)	45 (45.0)	0.655
Cardiovascular disease	26 (30.2)	27 (27.0)	0.626
Back pain	15 (17.4)	16 (16.0)	0.844

HAMD: Hamilton Depression Scale; HAMA: Hamilton Anxiety Scale.

Table 2 Comparison of functional recovery indicators between groups

Functional recovery indicator	Study group (n = 86)	Control group (n = 100)	P value
Postoperative hospital stay (days)	14.3 ± 3.7	10.6 ± 2.4	< 0.01
Knee function score at 3 months	68.2 ± 8.5	79.9 ± 7.3	< 0.05
Complication rate (%)	32.3	17.2	< 0.05
Surgical site infection rate (%)	18.6	9.5	< 0.05
Knee stiffness rate (%)	14.8	7.0	< 0.05
Persistent pain at 12 weeks (%)	25.6	12.3	< 0.01
Knee flexion ROM at 6 weeks (degrees)	98.4 ± 7.2	112.1 ± 8.9	< 0.01
Walking distance at 6 weeks (m)	227 ± 66	341 ± 89	< 0.001
Time to independent ambulation (days)	4.6 ±1.2	2.3 ± 0.5	< 0.01
Rehabilitation participation score	6.8 ± 1.3	8.5 ± 1.2	< 0.01
Treatment adherence rate (%)	67.5 ± 12.3	86.2 ± 9.8	< 0.01
Patient satisfaction score	6.4 ± 1.8	8.2 ± 1.4	< 0.01

ROM: Range of motion.

Table 3 Comparison of neuroendocrine and inflammatory markers between groups

Parameter	Study group (n = 86)	Control group (n = 100)	P value
Neuroendocrine markers
Morning serum cortisol (μg/dL)	22.4 ± 5.1	15.3 ± 4.2	< 0.01
Diurnal cortisol rhythm	Flattened	Normal	< 0.01
Evening cortisol (μg/dL)	12.3 ± 3.2	6.8 ± 2.1	< 0.01
Cortisol awakening response (% increase)	38.2 ± 9.3	72.4 ± 12.6	< 0.001
Urinary epinephrine (μg/24 hours)	18.7 ± 4.6	12.3 ± 3.8	< 0.05
Urinary norepinephrine (μg/24 hours)	65.2 ± 14.3	49.6 ± 12.5	< 0.05
Inflammatory markers
Drainage fluid IL-6 (pg/mL)	42.7 ± 9.5	26.4 ± 7.3	< 0.01
Drainage fluid TNF-α (pg/mL)	18.9 ± 4.3	11.2 ± 3.6	< 0.01
Serum C-reactive protein (mg/L)	38.4 ± 12.7	25.3 ± 9.9	< 0.05
Erythrocyte sedimentation rate (mm/hour)	52.6 ± 18.2	42.1 ± 16.4	< 0.05
Drainage fluid IL-1β (pg/mL)	15.6 ± 3.8	9.4 ± 2.7	< 0.01
Anti-inflammatory IL-10 (pg/mL)	6.3 ± 1.7	11.2 ± 2.4	< 0.01

IL: Interleukin; TNF-α: Tumor necrosis factor α.

Table 4 Sleep quality assessment results

Parameter	Study group	Control group	P value
Pittsburgh Sleep Quality Index	12.3 ± 3.1	7.5 ± 2.4	< 0.001
Total sleep time (hours)	5.2 ± 1.1	6.8 ± 0.9	< 0.01
Sleep fragmentation	Increased	Normal	Not specified
Sleep latency (minutes)	42.7 ± 18.5	23.4 ± 11.2	< 0.01
Sleep efficiency (%)	68.3 ± 8.7	84.6 ± 6.2	< 0.01
REM sleep (% of total)	16.2 ± 4.3	23.8 ± 3.7	< 0.01
Nocturnal awakenings (count)	6.4 ± 2.1	3.1 ± 1.4	< 0.001
Daytime sleepiness (ESS score)	11.8 ± 3.6	6.4 ± 2.8	< 0.01

REM: Rapid eye movement; ESS: Epworth Sleepiness Scale.

Table 5 Expanded quality of life measurements

Domain	Study group	Control group	P value
Physical well-being	41.2 ± 8.7	58.4 ± 9.1	< 0.001
Psychological well-being	38.6 ± 7.9	62.3 ± 8.5	< 0.001
Social functioning	43.5 ± 9.2	59.7 ± 8.8	< 0.001
Pain experience	62.8 ± 10.3	45.2 ± 9.7	< 0.001
Treatment satisfaction	40.3 ± 8.5	67.1 ± 9.4	< 0.001
Independence/self-care	39.4 ± 7.8	56.8 ± 8.2	< 0.001
Perceived body image	35.2 ± 9.1	53.7 ± 8.6	< 0.001
Caregiver burden	60.1 ± 11.4	42.5 ± 9.8	< 0.01
Overall quality of life	37.8 ± 6.9	60.4 ± 7.8	< 0.001