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Shang S, Hu Y, Wang H, Rao RQ, Zhang F. Preoperative anxiety and psychological determinants of functional recovery after total knee arthroplasty: A retrospective cohort study. World J Psychiatry 2026; 16(3): 113625 [DOI: 10.5498/wjp.v16.i3.113625]
World J Psychiatry. Mar 19, 2026; 16(3): 113625 Published online Mar 19, 2026. doi: 10.5498/wjp.v16.i3.113625
Preoperative anxiety and psychological determinants of functional recovery after total knee arthroplasty: A retrospective cohort study
Song Shang, Yu Hu, Hai Wang, Rui-Qiang Rao, Fan Zhang
Song Shang, Hai Wang, Rui-Qiang Rao, Fan Zhang, Department of Orthopedics, Chongqing University Fuling Hospital, Chongqing 408000, China
Yu Hu, Department of Emergency, Chongqing University Fuling Hospital, Chongqing 408000, China
Author contributions: Shang S drafted the manuscript; Shang S, Wang H, and Rao RQ performed patient enrollment and data collection; Hu Y conducted psychological assessments; Shang S and Wang H analyzed the data; Shang S and Zhang F conceived and designed the study; and all authors critically revised and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Chongqing University Fuling Hospital, approval No. 2025CDFSFLYYEC-27.
Informed consent statement: Given the retrospective design of this study, the requirement for written informed consent was waived by the Institutional Review Board. All patient data were anonymized and handled with strict confidentiality.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Song Shang, Department of Orthopedics, Chongqing University Fuling Hospital, No. 2 Gaosongtang Road, Fuling District, Chongqing 408000, China. shangsong20251@163.com
Received: September 28, 2025 Revised: October 29, 2025 Accepted: December 12, 2025 Published online: March 19, 2026 Processing time: 153 Days and 0.2 Hours
Core Tip
Core Tip: This study highlights the significant role of preoperative anxiety in determining functional recovery after total knee arthroplasty. Patients with elevated anxiety levels experienced longer hospital stays, poorer knee function, and higher complication rates. Mechanistic analyses revealed dysregulated neuroendocrine stress responses, increased pro-inflammatory cytokines, impaired treatment adherence, and sleep disturbances as mediating pathways. These findings underscore preoperative anxiety as a modifiable risk factor and emphasize the importance of integrating psychological assessment and targeted interventions into perioperative care. A multidisciplinary approach addressing both mental health and physical rehabilitation may optimize recovery outcomes.
