Depression/Anxiety as a Risk Factor
Limited evidence supports that patients with depression and/or anxiety symptoms have less improvement in patient reported outcomes with total knee arthroplasty (TKA).

Rationale
One moderate quality study (Duiven 2013) and one low quality paper (Singh 2010) demonstrated less good outcomes in patients with anxiety/depression. There only being one moderate quality paper, the recommendation made was that limited evidence supports that patients with depression and/or anxiety symptoms have less improvement in patient reported outcomes with total knee arthroplasty.