To Örebro University

The overall aim of this thesis was to study patients with anxiety/depression symptoms before and after primary total knee replacement, particularly in terms of improvements in patients-reported outcomes, and particularly among those who were discontent with the surgery. This could hopefully improve patients' contentment after TKR.

Study I investigated the prevalence of knee symptom improvement among patients with preoperative anxiety and/or depression in comparison to patients who did not have anxiety/depression. Study II investigated changes in the prevalence of anxiety and depression one year after primary TKR. Study III investigated how TKR surgeons in Sweden informed their patients preoperatively, and what kind of information they gave. Study IV used face-to-face interviews to capture experiences of discontentment one year after TKR among patients without documented complications.

The main findings were that: 1. All patients improved in outcome measures one year after TKR, regardless of presurgical psychological state. 2. Among the 15% of patients with anxiety symptoms before surgery, 59% had improved in these symptoms one year after surgery; while among the 10% with depression symptoms before surgery, 60% had improved one year after surgery. 3. Knee surgeons in Sweden have considerable awareness of the importance of preoperative patient information, the impact of patient expectations, and psychiatric illness. However, they need to improve their preoperative routines when it comes to providing written information, asking about the patient’s expectations, and psychiatric assessment. 4. The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and lacking relational support.