Exploratory analysis of depressive symptom trajectories before and after hip or knee arthroplasty in geriatric patients

TL;DR

This study explores how depressive symptoms change in older patients before and after hip or knee replacement surgery.

Contribution

The study provides exploratory evidence that hip and knee arthroplasty may improve depressive symptoms in geriatric patients.

Findings

Depressive symptoms significantly decreased from baseline to 3 months post-surgery in geriatric patients.

Patients with elevated baseline depressive symptoms showed the largest improvements after surgery.

Improvements in depressive symptoms were most notable in the early postoperative period.

Abstract

Depressive symptoms are prevalent among patients with osteoarthritis (OA), particularly in geriatric patients. Pain and mood are closely interconnected, with chronic joint pain contributing significantly to psychological distress. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are established procedures that improve pain and physical function and may also influence depressive symptoms. The objective of this study was to evaluate changes in depressive symptoms following THA and TKA in geriatric patients.

In this prospective pilot study, we analysed data from 143 participants enrolled in the ongoing Special Orthopaedic Geriatrics (SOG) trial, funded by the German Federal Joint Committee (G-BA). Depressive symptoms were assessed using the Geriatric Depression Scale (GDS) preoperatively and at 3 days, 7 days, 4 weeks, and 3 months after surgery. Depressive symptoms were analysed in two predefined groups: the total sample (GDS 1–15) and patients with elevated baseline symptoms (GDS 6–15). Statistical analysis included the Friedman test for repeated measures, followed by post-hoc testing.

In the overall cohort, median GDS scores decreased from 3 at baseline to 2 at the 3-month follow-up (p < 0.001). In the subgroup with elevated baseline symptoms (GDS 6–15), median scores declined from 8.5 at baseline to 4 at 3 months (p < 0.001). Improvements were observed after both THA and TKA, with changes appearing more pronounced in THA.

THA and TKA were associated with modest improvements in depressive symptoms across the full range of baseline GDS scores. While patients with elevated baseline symptoms showed larger absolute changes, improvements were also observed in those without abnormal baseline scores. Improvements in depressive symptoms were most pronounced between the preoperative and early postoperative assessments, whereas only minor additional changes were observed during later postoperative follow-up. These findings should be interpreted as exploratory and require confirmation in larger controlled studies.

This study is part of the Special Orthopaedic Geriatrics (SOG) trial, German Clinical Trials Register DRKS00024102. Registered on 19 January 2021.

The online version contains supplementary material available at 10.1007/s00402-026-06268-6.

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