The impact of depression on outcomes in revision knee replacement surgery

Abstract

Introduction Revision total knee arthroplasty is associated with more variable functional recovery and greater postoperative burden than primary surgery. Depression may influence recovery, but its effect in revision knee replacement remains incompletely defined. Objective To synthesise evidence on the association between depression or poor preoperative mental health and outcomes after revision total knee arthroplasty. Methods PubMed, MEDLINE, and Embase were searched on August 12, 2025. Adult revision total knee arthroplasty studies assessing depression or mental health in relation to postoperative outcomes were eligible. Owing to heterogeneity in exposure definitions, outcomes, and follow-up, findings were narratively synthesised. Results Of 103 records identified, 44 duplicates were removed and 59 records screened; 6 studies were included. Depression or poorer preoperative mental health was associated with worse postoperative function, persistent pain, greater narcotic analgesic use, lower satisfaction, infection, reoperation or re-revision, readmission, emergency department attendance, prolonged stay, non-home discharge, and higher costs. However, patients with poorer mental health could still achieve clinically meaningful functional improvement. Conclusion Depression is associated with poorer outcomes after revision total knee arthroplasty but should not be considered a contraindication to surgery. Mental health recognition, expectation-setting, and multidisciplinary optimisation may improve perioperative care.