Archives of Orthopaedic and Trauma Surgery - 2026-03-28 - Journal Article
Exploratory analysis of depressive symptom trajectories before and after hip or knee arthroplasty in geriatric patients.
Schiegl J, Bammert P, Maderbacher G, Reinhard J, Pagano S, Michalk K, Grifka J, Kappenschneider T
Topics
Key Takeaway
In geriatric patients undergoing THA or TKA, median Geriatric Depression Scale scores declined from 8.5 to 4 at 3 months in those with elevated baseline symptoms (GDS 6–15), with most improvement occurring in the early postoperative period.
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Summary
This prospective pilot study evaluated GDS trajectories at 5 time points (preop, POD3, POD7, 4 weeks, 3 months) in 143 geriatric patients undergoing THA or TKA within the SOG trial. Overall cohort median GDS dropped from 3 to 2 (p<0.001); the elevated-baseline subgroup (GDS 6–15) showed a clinically larger decline from 8.5 to 4 (p<0.001). The majority of improvement occurred between the preoperative and early postoperative assessments, with minimal additional change thereafter.
Key Limitation
The absence of a non-operative control group prevents distinguishing surgery-specific effects from regression to the mean or spontaneous mood fluctuation over the same 3-month period.
Original Abstract
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
TRIAL REGISTRATION
This study is part of the Special Orthopaedic Geriatrics (SOG) trial, German Clinical Trials Register DRKS00024102. Registered on 19 January 2021.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s00402-026-06268-6.