Preoperative anxiety and depression predict two-year outcomes after total hip or knee arthroplasty

Table 1 Comparison of baseline characteristics between the two groups before and after propensity score matching, n (%)

Variable	Before matching			After matching
	Exposed group (n = 108)	Non-exposed group (n = 138)	P value	Exposed group (n = 92)	Non-exposed group (n = 92)	P value
General demographic characteristics
Age (years), mean ± SD	62.4 ± 8.7	60.8 ± 9.3	0.172	62.1 ± 8.5	61.8 ± 8.9	0.811
Gender			0.043			0.856
Male	38 (35.2)	68 (49.3)		36 (39.1)	37 (40.2)
Female	70 (64.8)	70 (50.7)		56 (60.9)	55 (59.8)
BMI (kg/m2), mean ± SD	26.3 ± 3.4	25.6 ± 3.2	0.098	26.1 ± 3.3	25.9 ± 3.4	0.682
Education level			0.156			0.791
Junior high school or below	45 (41.7)	48 (34.8)		38 (41.3)	36 (39.1)
High school/technical secondary school	38 (35.2)	52 (37.7)		33 (35.9)	35 (38.0)
College or above	25 (23.1)	38 (27.5)		21 (22.8)	21 (22.9)
Marital status			0.287			0.924
Married	89 (82.4)	121 (87.7)		77 (83.7)	78 (84.8)
Unmarried/divorced/widowed	19 (17.6)	17 (12.3)		15 (16.3)	14 (15.2)
Surgery-related data
Surgery type			0.029			0.887
THA	58 (53.7)	92 (66.7)		52 (56.5)	53 (57.6)
TKA	50 (46.3)	46 (33.3)		40 (43.5)	39 (42.4)
Surgical side			0.521			0.832
Left	51 (47.2)	71 (51.4)		45 (48.9)	46 (50.0)
Right	57 (52.8)	67 (48.6)		47 (51.1)	46 (50.0)
Primary disease			0.412			0.765
Osteoarthritis	76 (70.4)	104 (75.4)		67 (72.8)	69 (75.0)
Femoral head necrosis	24 (22.2)	26 (18.8)		19 (20.7)	18 (19.6)
Other	8 (7.4)	8 (5.8)		6 (6.5)	5 (5.4)
Comorbidities
Hypertension	46 (42.6)	51 (37.0)	0.379	38 (41.3)	37 (40.2)	0.879
Diabetes	28 (25.9)	30 (21.7)	0.447	23 (25.0)	22 (23.9)	0.867
Cardiovascular disease	15 (13.9)	14 (10.1)	0.369	12 (13.0)	11 (12.0)	0.826
Preoperative laboratory indicators
Hemoglobin (g/L), mean ± SD	128.6 ± 15.3	131.4 ± 14.8	0.143	129.2 ± 15.1	130.1 ± 14.6	0.687
Albumin (g/L), mean ± SD	39.8 ± 4.2	40.6 ± 3.9	0.112	40.1 ± 4.1	40.3 ± 4.0	0.738
Fasting blood glucose (mmol/L), mean ± SD	5.8 ± 1.3	5.6 ± 1.2	0.238	5.7 ± 1.3	5.7 ± 1.2	0.914

THA: Total hip arthroplasty; TKA: Total knee arthroplasty; BMI: Body mass index.

Table 2 Comparison of preoperative and postoperative joint function scores between the two groups (mean ± SD, points)¹

Surgery type	Group	n	Preoperative	1 year postoperative	2 years postoperative	F time	P time	F between-groups	P between-groups	F interaction	P interaction
THA (Harris Score)	Exposed group	52	46.3 ± 8.5	78.4 ± 9.2	82.6 ± 8.7	486.32	< 0.001	18.74	< 0.001	6.85
	Non-exposed group	53	47.1 ± 8.2	85.7 ± 7.4	89.3 ± 6.9
	t-value		0.485	4.526	4.389
	P value		0.629	< 0.001	< 0.001
TKA (HSS Score)	Exposed group	40	48.6 ± 9.3	76.2 ± 8.6	80.8 ± 8.3	412.67	< 0.001	15.28	< 0.001	5.92	0.004
	Non-exposed group	39	49.2 ± 8.9	83.4 ± 7.2	87.1 ± 7.5
	t-value		0.295	4.058	3.546
	P value		0.769	< 0.001	0.001

¹P-values for between-group comparisons at postoperative time points have been Bonferroni-corrected (since two time points were compared - 1 year and 2 years postoperatively - the correction factor is 2, with adjusted α level of 0.025).

THA: Total hip arthroplasty; TKA: Total knee arthroplasty; HSS: Hospital for Special Surgery.

Table 3 Comparison of preoperative and postoperative pain Visual Analogue Scale scores between the two groups (mean ± SD, points)¹

Pain state	Group	n	Preoperative	1 year postoperative	2 years postoperative
At rest	Exposed group	92	4.8 ± 1.6	1.8 ± 0.9	1.5 ± 0.8
	Non-exposed group	92	4.7 ± 1.5	1.2 ± 0.7	0.9 ± 0.6
	t-value		0.432	4.986	5.437
	P value		0.666	< 0.001	< 0.001
During activity	Exposed group	92	6.9 ± 1.8	2.6 ± 1.1	2.2 ± 1.0
	Non-exposed group	92	6.8 ± 1.7	1.7 ± 0.9	1.3 ± 0.8
	t-value		0.379	5.974	6.526
	P value		0.705	< 0.001	< 0.001

¹Simple effect analysis showed that between-group differences were mainly reflected at the 1-year and 2-year postoperative time points. Repeated measures ANOVA showed that the time effect, between-group effect, and interaction effect were all statistically significant.

VAS: Visual Analogue Scale.

Table 4 Comparison of preoperative and 2-year postoperative Short Form-36 Health Survey quality of life scores between the two groups (mean ± SD, points)¹

Dimension	Exposed group (n = 92)		Non-exposed group (n = 92)		Change (2 years postoperative - preoperative)
	Preoperative	2 years postoperative	Preoperative	2 years postoperative	Exposed group	Non-exposed group
Physical functioning	42.6 ± 12.3	71.4 ± 13.8	43.2 ± 11.9	81.7 ± 11.2	28.8 ± 10.5	38.5 ± 9.8
Role physical	38.5 ± 15.6	68.3 ± 16.4	39.1 ± 14.8	79.2 ± 13.7	29.8 ± 12.7	40.1 ± 11.3
Bodily pain	35.7 ± 13.2	72.8 ± 14.6	36.3 ± 12.8	83.5 ± 12.3	37.1 ± 11.9	47.2 ± 10.6
General health	48.3 ± 14.5	64.7 ± 15.2	49.1 ± 13.9	74.9 ± 13.6	16.4 ± 9.8	25.8 ± 9.2
Vitality	46.2 ± 13.7	62.5 ± 14.3	47.1 ± 13.2	72.8 ± 12.8	16.3 ± 10.4	25.7 ± 9.6
Social functioning	51.4 ± 15.3	70.2 ± 14.9	52.3 ± 14.8	81.6 ± 13.2	18.8 ± 11.2	29.3 ± 10.5
Role emotional	44.8 ± 16.2	66.9 ± 15.7	45.6 ± 15.7	78.3 ± 14.5	22.1 ± 12.3	32.7 ± 11.8
Mental health	49.5 ± 14.8	65.3 ± 15.6	50.3 ± 14.2	76.8 ± 13.9	15.8 ± 10.7	26.5 ± 9.9

¹Change represents the 2-year postoperative score minus the preoperative score, indicating the magnitude of improvement; change comparison used an independent samples t-test.

SF-36: Short Form-36 Health Survey.

Table 5 Comparison of complication occurrence at 2 years postoperatively between the two groups, n (%)

Complication type	Exposed group (n = 92)	Non-exposed group (n = 92)	χ2 value	P value
Periprosthetic infection	6 (6.5)	1 (1.1)
Venous thromboembolism	8 (8.7)	2 (2.2)
Prosthetic loosening	5 (5.4)	1 (1.1)
Prosthetic dislocation	2 (2.2)	1 (1.1)
Heterotopic ossification	3 (3.3)	2 (2.2)
Chronic pain	7 (7.6)	2 (2.2)
Poor wound healing	2 (2.2)	1 (1.1)
Delayed wound healing	2 (2.2)	3 (3.3)
Joint stiffness	2 (2.2)	1 (1.1)
Total complication rate	27 (29.3)	13 (14.1)	6.582	0.01

Table 6 Multivariate logistic regression analysis of the impact of preoperative anxiety and depression on 2-year postoperative outcomes¹

Dependent variable	Independent variable	β	SE	Wald χ2	P value	OR	95%CI
Poor joint function at 2 years postoperatively	Preoperative anxiety and depression (yes vs no)	1.346	0.353	14.532	< 0.001	3.84	1.92-7.68
(n = 48/184, 26.1%)	Age (≥ 65 years vs < 65 years)2	0.682	0.328	4.325	0.038	1.98	1.04-3.77
	Gender (female vs male)	0.245	0.315	0.605	0.437	1.28	0.69-2.37
	BMI (≥ 28 kg/m2 vs < 28 kg/m2)3	0.534	0.336	2.526	0.112	1.71	0.88-3.31
	Surgery type (TKA vs THA)	0.412	0.308	1.786	0.181	1.51	0.83-2.76
	Hypertension (yes vs no)	0.328	0.321	1.043	0.307	1.39	0.74-2.61
	Diabetes (yes vs no)	0.587	0.342	2.947	0.086	1.8	0.92-3.52
Complication occurrence at 2 years postoperatively	Preoperative anxiety and depression (yes vs no)	0.982	0.374	6.895	0.009	2.67	1.28-5.57
(n = 40/184, 21.7%)	Age (≥ 65 years vs < 65 years)2	0.738	0.352	4.397	0.036	2.09	1.05-4.16
	Gender (female vs male)	0.186	0.342	0.296	0.586	1.2	0.61-2.37
	BMI (≥ 28 kg/m2 vs < 28 kg/m2)3	0.624	0.361	2.989	0.084	1.87	0.92-3.79
	Surgery type (TKA vs THA)	0.298	0.335	0.791	0.374	1.35	0.70-2.60
	Hypertension (yes vs no)	0.453	0.347	1.704	0.192	1.57	0.80-3.10
	Diabetes (yes vs no)	0.712	0.368	3.743	0.053	2.04	0.99-4.19

¹Numbers in parentheses represent the number of outcome events/total number of cases (incidence %).

²Age classification threshold of 65 years based on the demographic definition of the elderly.

³Body mass index classification threshold of 28 kg/m² based on Chinese adult obesity diagnostic standard (WS/T 428-2013); Hosmer-Lemeshow goodness-of-fit test P-values for both models are > 0.05, indicating good model fit.

OR: Odds ratio; CI: Confidence interval; THA: Total hip arthroplasty; TKA: Total knee arthroplasty; BMI: Body mass index.