Preoperative anxiety and psychological determinants of functional recovery after total knee arthroplasty: A retrospective cohort study

BACKGROUND Total knee arthroplasty (TKA) is an effective treatment for end-stage knee joint disease, but postoperative functional recovery outcomes vary significantly among patients. In recent years, researchers have increasingly focused on the influence of psychological factors on surgical outcomes, yet studies on the impact of preoperative anxiety on functional recovery after TKA remain relatively limited. AIM To investigate the effects of preoperative anxiety levels on functional recovery outcomes following TKA, providing a more comprehensive treatment strategy for clinical practice. METHODS A retrospective cohort study design was employed to collect clinical data from 186 patients who underwent TKA at a tertiary hospital between January 2020 and December 2023. Patients were divided into a study group (86 cases) and a control group (100 cases) based on preoperative anxiety status. The Hamilton Anxiety Scale and Hamilton Depression Scale were used to assess patients’ mental status. Postoperative rehabilitation time, joint function scores, complication rates, and other indicators were compared between the two groups. Multivariate logistic regression analysis was conducted to determine independent risk factors affecting functional recovery. RESULTS Compared to the control group, the study group showed significantly longer postoperative hospital stays [(14.3 ± 3.7) days vs (10.6 ± 2.4) days, P < 0.01], lower knee function scores at 3 months postoperatively [(68.2 ± 8.5) vs (79.9 ± 7.3), P < 0.05], and higher complication rates (32.3% vs 17.2%, P < 0.05). Multivariate analysis identified high preoperative anxiety levels [odds ratio (OR) = 2.47, 95% confidence interval (CI): 1.82-3.36], chronic stress (OR = 1.94, 95%CI: 1.43-2.65), and lack of social support (OR = 1.76, 95%CI: 1.21-2.54) as independent risk factors affecting postoperative functional recovery. Analysis of neuroendocrine and immune indicators revealed elevated stress hormone levels and abnormal expression of inflammatory factors in the study group, which may represent important mechanisms through which anxiety affects postoperative rehabilitation. CONCLUSION Preoperative anxiety is a significant factor influencing functional recovery following TKA. It interferes with the rehabilitation process through multiple pathways, including impacts on patients' self-care behaviors, sleep quality, endocrine function, and immune responses.