The Impact of Major Depressive Disorder on Postoperative Somatic and Psychiatric Complications Following Total Knee Arthroplasty: A Database Study.

Abstract

Major depressive disorder (MDD) is a psychiatric condition characterized by persistent low mood, anhedonia, sleep disturbances, guilt, fatigue, impaired concentration, appetite changes, psychomotor abnormalities, and suicidal ideation. It is a prevalent comorbidity among patients undergoing total knee arthroplasty (TKA) and may affect recovery. While prior research has emphasized pain and functional outcomes, the broader impact of MDD on postoperative psychiatric, systemic, and mortality outcomes remains underexplored. This study investigated whether MDD is independently associated with increased risk of newly diagnosed psychiatric, somatic, and mortality complications following primary TKA. In a novel analysis of a large electronic health record network, we identified adult patients undergoing primary, elective TKA from 2015 to 2024, excluding those who had prior knee pathology or psychiatric diagnoses other than MDD. A propensity score matching analysis adjusted for demographics, comorbidities, laboratory values, and medication use was used to compare postoperative outcomes at 90 days and one year using odds ratios (OR). Compared to controls, MDD patients experienced significantly higher odds of developing generalized anxiety disorder (OR_90day 13.66; OR_1year 11.73), adjustment disorder (OR_90day 11.11; OR_1year 6.91), post-traumatic stress disorder (OR_90day 6.57; OR_1year 10.70), schizophrenia (OR_90day 4.02; OR_1year 4.40), suicide (OR_90day 6.88; OR_1year 8.93), and dementia (OR_90day 16.05; OR_1year 12.47). Substance-related disorders also increased in TKA patients who have MDD, including alcohol use (OR_90day 4.73; OR_1year 2.93) and opioid use at one year (OR_1year 2.61). Elevated odds were observed for chest pain (OR_90day 1.87; OR_1year 1.26), dizziness (OR_90day 1.43; OR_1year 1.53), shortness of breath (OR_90day 1.66; OR_1year 1.42), and mortality (OR_90day 4.33; OR_1year 3.39) for TKA patients who have MDD. Emergency department utilization was significantly higher at one year. Among patients undergoing primary, elective TKA, MDD was independently associated with increased risk of new-onset psychiatric diagnoses, systemic complications, and mortality beyond traditional orthopaedic outcomes.