Impact of depression on functional status in elderly patients undergoing total knee arthroplasty

Table 1 Demographic characteristics of the population of depressed and non-depressed elderly adults that underwent total knee arthroplasty, n (%)

Characteristic	With depression (n = 22)	Without depression (n = 78)	P value
Female sex	14 (64)	51 (65)	0.9
Age (years)	77.6 ± 6	80.6 ± 6.3	0.05
Body mass index	31.4 ± 6.3	30.8 ± 4.7	0.6
Charlson index (IQR)	1 (0-1)	1 (0-2)	0.1
Diabetes	2 (9)	14 (18)	0.5
Hypertension	16 (73)	70 (90)	0.04
Hypothyroidism	2 (9)	23 (29)	0.06
Number of medications used	6.6 ± 3.5	7.6 ± 3.2	0.2
Older Americans Resources and Services Social Resource Scale (IQR)	1.5 (1-2)	1 (1-2)	0.3
Use of antidepressant medication	7 (32)	20 (26)	0.6
Use of Potentially Inappropriate Medication (Beers Criteria)	18 (82)	50 (64)	0.1
ADL (IQR)	4.5 (4-5)	5 (4-6)	0.2
Decreased ADL (< 6)	18 (82)	49 (63)	0.09
IADL (IQR)	6 (3-7)	6 (4-8)	0.3
Decreased IADL (< 6)	10 (45)	27 (35)	0.4
Clock-Drawing test (IQR)	5 (3-6)	6 (5-7)	0.06
Cognitive Impairment (Mini Mental score < 24 or Mini-Cog < 3)	6 (27)	27 (35)	0.5
Impaired gait speed test (more than 7 seconds per 4.5 meters)	15 (71)	47 (62)	0.5
Impaired chair stand test (greater than 15 seconds)	18 (95)	53 (79)	0.2
Risk factors for Confusional Syndrome	8 ± 2	6.5 ± 2.2	0.006
Edmonton Frail Scale	8 ± 2.5	5.8 ± 2.6	0.0006
Frailty according to Edmonton (≥ 7)	15 (68)	33 (42)	0.05
Fried Frailty Index	3.3 ± 1.2	2.5 ± 1.3	0.01
Frailty according to Fried (≥ 3)	17 (77)	42 (54)	0.05
Number of falls in the past year	12 (55)	28 (36)	0.1
Hand Grip (kg) (IQR)	18.5 (12-27)	19 (14-28)	0.5
Preoperative Knee KSS	27.4 ± 20.7	33.6 ± 16.5	0.2
Preoperative Functional KSS	31.8 ± 19.6	33.2 ± 21.2	0.8

ADL: Activities of daily living; IADL: Instrumental activities of daily living; IQR: Interquartile range; KSS: Knee Society Score.

Table 2 Variation between pre and postoperative functional status in patients with depression and without depression

Variable	Total (n = 90)	With depression (n = 21)	Without depression (n = 69)	P value
Postoperative Functional KSS	66 ± 20.6	65 ± 22.1	66.3 ± 20.3	0.8
Postoperative Knee KSS	78 ± 13	78.9 ± 10.4	78.4 ± 13.7	0.9
Delta Functional KSS	34.4 ± 23.7	33.8 ± 27.2	34.5 ± 22.7	0.9
Delta Knee KSS	46.1 ± 19.6	50.2 ± 19.5	44.9 ± 19.5	0.3

Values are expressed as means ± SD. KSS: Knee Society Score.

Table 3 Frequency of combined events (death or major complication) at 3 months postoperative in patients with and without depression, n (%)

Characteristic	With depression (n = 21)	Without depression (n = 75)	P value
Combined final event: Major complication or death.	4 (19)	16 (21.3)	1
Cerebrovascular accident (stroke)	1 (4.8)	0 (0)	N/A
Arrhythmia	0 (0)	1 (1.3)	N/A
Acute coronary event	0 (0)	1 (1.3)	N/A
Heart failure	0 (0)	5 (6.7)	N/A
Non-prosthetic infection	1 (4.8)	2 (2.7)	0.5
Periprosthetic infection	0 (0)	1 (1.3)	N/A
Acute renal failure	1 (4.8)	4 (5.3)	1
Major bleeding	0 (0)	2 (2.7)	N/A
Deep vein thrombosis/pulmonary embolism	1 (4.8)	5 (6.7)	1
Death	0 (0)	1 (1.3)	N/A

N/A: Not applicable.

Table 4 Association of depression, age, frailty and high disease burden with the combined final endpoint through multivariate logistic regression analysis

Independent variable	Odd ratio (95%CI)	P value
Depression	1.2 (0.3–4.8)	0.8
Age	1.1 (1–1.2)	0.06
Frailty (Fried Score ≥ 3)	1.7 (0.5-6)	0.4
High Disease Burden (Charlson ≥ 2)	1.3 (0.4–4.4)	0.7

Table 5 Comparison of other primary results among patients with and without depression, n (%)

Variable	With depression (n = 22)	Without depression (n = 78)	P value
Length of hospital stay	4.5 ± 1.9	4.6 ± 2.9	0.8
Readmission	2 (9)	8 (10)	1
Number of required sessions of physical therapy (IQR)	10 (10–10)	10 (10–10)	0.8
Number of consultations to the surgical team (IQR)	4 (3–4)	4 (3–4)	0.3

IQR: Interquartile range.