Nicolino TI, Smietniansky M, Boietti B, Garcia-Mansilla I, Carbo L, Martinez CB. Impact of depression on functional status in elderly patients undergoing total knee arthroplasty. World J Methodol 2025; 15(4): 102758 [DOI: 10.5662/wjm.v15.i4.102758]
Corresponding Author of This Article
Ignacio Garcia-Mansilla, MD, Division of Knee, Hospital Italiano de Buenos Aires, Juan Domingo Perón 4190, Buenos Aires 1109, Argentina. ignaciogmansilla@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Methodol. Dec 20, 2025; 15(4): 102758 Published online Dec 20, 2025. doi: 10.5662/wjm.v15.i4.102758
Impact of depression on functional status in elderly patients undergoing total knee arthroplasty
Tomas Ignacio Nicolino, Maximiliano Smietniansky, Bruno Boietti, Ignacio Garcia-Mansilla, Lisandro Carbo, Cintia Belen Martinez
Tomas Ignacio Nicolino, Ignacio Garcia-Mansilla, Lisandro Carbo, Division of Knee, Department of Orthopaedics, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina
Maximiliano Smietniansky, Program for Determination and Management of Risks for Practices and Procedures and Preoperative Evaluation, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina
Bruno Boietti, Cintia Belen Martinez, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina
Author contributions: Nicolino TI and Smietniansky M participated in the conception and design of the study and were involved in the acquisition, analysis, or interpretation of data; Boietti B, Garcia-Mansilla I, and Carbo L accessed and verified the study data; Martinez CB wrote the manuscript; all authors critically reviewed and provided final approval of the manuscript, were responsible for the decision to submit the manuscript for publication.
Institutional review board statement: The present study will be conducted in accordance with the ethical considerations for the care of participants in clinical research outlined in the Declaration of Helsinki and in compliance with the Guidelines for Research in Human Health (Resolution 1480/11) of the National Ministry of Health.
Informed consent statement: This is a retrospective study, meaning there is no risk to the patient, nor does it require the informed consent process. All information obtained from the electronic health records (EHR) will be used by the researchers with the strictest confidentiality, in accordance with the provisions of Law 25.326 on data protection. To ensure this, each patient will be assigned a consecutive number in a database accessible only to the principal investigator, which will be password-protected on a secured computer. Since the patients included in the study have already been discharged from follow-up and the nature of the study is observational and retrospective, with data collection exclusively from medical records—without requiring the active participation of patients or posing any harm to them or their healthcare coverage—informed consent will not be required for their inclusion in this study.
Conflict-of-interest statement: The author(s) declare that there are no conflicts of interest regarding the publication of this article. No financial or personal relationships have influenced the research or the preparation of this manuscript.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ignacio Garcia-Mansilla, MD, Division of Knee, Hospital Italiano de Buenos Aires, Juan Domingo Perón 4190, Buenos Aires 1109, Argentina. ignaciogmansilla@gmail.com
Received: October 28, 2024 Revised: February 26, 2025 Accepted: March 17, 2025 Published online: December 20, 2025 Processing time: 280 Days and 12.9 Hours
Abstract
BACKGROUND
The prevalence of depressive symptoms in patients undergoing total knee arthroplasty (TKA) ranges from 22% to 26%. The impact of depression on functional status post-TKA remains controversial.
AIM
To be the first study in Latin American population to evaluate the association between depression and functional status one year after TKA, hypothesizing that elderly patients with depression will demonstrate lower rates of functional improvement.
METHODS
We conducted an observational, descriptive and analytic, retrospective cohort study involving patients over 65 years old who were indicated for TKA. Assessments were made via the Program for Determination and Management of Risks for Practices and Procedures of the Division of Geriatric Medicine at the Italian Hospital of Buenos Aires, between June 2015 and July 2019. Depression screening was conducted using Yesavage’s abbreviated score and Patient Health Questionnaire-9, while functional ability was evaluated using the Knee Society Score (KSS).
RESULTS
Of the 100 patients analyzed, 22 (22%) screened positive for depression. The mean age was 80 years ± 6.3 years, with an average of 77.6 years ± 6 years in the depressed group and 80.6 years ± 6.3 years in the non-depressed group (P = 0.05). Depressed patients showed significantly greater cognitive impairment [clock-face drawing test median: 5 (3-6) vs 6 (5-7), P = 0.06] and more risk factors for confusional syndrome (mean: 8 ± 2 vs 6.5 ± 2.2, P = 0.006). Frailty was also more prevalent in depressed patients [Edmonton: 15 (68%) vs 33 (42%), P = 0.05; Fried: 17 (77%) vs 42 (54%), P = 0.05]. Postoperative Functional KSS were similar between groups (depressed: 65 ± 22.1 vs non-depressed: 66.3 ± 20.3, P = 0.8). Linear regression analysis revealed no association between depression and changes in KSS. Spearman’s rank correlation coefficients were -0.0304 (P = 0.8) for Functional KSS variation and -0.1 (P = 0.3) for KSS variation.
CONCLUSION
Depression in patients with osteoarthritis should not hinder surgical planning. Identifying and treating depression preoperatively may enhance outcomes such as pain relief and reduce risks of acute confusional syndrome, cognitive impairment, and frailty.
Core Tip: This study evaluates the relationship between depression and functional outcomes one year after total knee arthroplasty (TKA) in elderly patients. Results indicate that while depressive symptoms are common, they do not impact functional recovery as measured by the Knee Society Score. However, depression correlates with greater cognitive impairment, increased frailty, and higher risk of confusional syndrome. These findings suggest that depression should not be a barrier to TKA, though preoperative identification and management of depressive symptoms may improve postoperative quality of life and reduce complications.
