Anxiety and Depressive Symptoms Before and After Total Hip and Knee Arthroplasty: An Observational Study

Abstract

Background: Osteoarthritis is frequently accompanied by anxiety and depressive symptoms, yet the perioperative trajectory of these symptoms after total hip or knee arthroplasty in real-world care remains incompletely defined. Objective: To quantify pre- to postoperative change in anxiety–depressive symptom burden among adults undergoing total hip or knee arthroplasty using the DASS-21 and to outline implications for perioperative care. Methods: In a prospective observational cohort at Memon Medical Institute Hospital (Karachi, Pakistan), consecutive adults ≥40 years scheduled for primary arthroplasty for radiographic osteoarthritis completed the DASS-21 ≤14 days preoperatively and at routine postoperative follow-up. The primary outcome was the within-patient change in the composite DASS-21 score (0–126). Paired t-tests evaluated pre–post differences; descriptive 95% confidence intervals (CIs) were calculated for time-point means. Results: Eighty-two patients were analyzed (50.0% female). Mean composite DASS-21 declined from 41.85±12.11 preoperatively (95% CI 39.19–44.51) to 12.84±6.92 postoperatively (95% CI 11.32–14.36), an absolute reduction of 29.01 points corresponding to a 69.3% decrease versus baseline (p=0.001). Conclusion: Total hip or knee arthroplasty was associated with a substantial reduction in anxiety–depressive symptoms measured by DASS-21, aligning with the study objective to quantify perioperative psychological change. Integrating brief mental-health screening and expectation management into standard pathways may help identify high-risk patients and guide targeted support to enhance rehabilitation engagement and patient-reported outcomes; multi-time-point, adjusted analyses are warranted.