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

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.