Association between pre-operative anxiety and/or depression and outcomes following total hip or knee arthroplasty

Abstract

Purpose: While elective primary total hip (THA) and knee (TKA) arthroplasty are effective procedures for addressing the symptoms associated with advanced osteoarthritis, there is evidence to suggest that patient anxiety and depression are linked to poorer outcomes following surgery. Methods: A secondary analysis of prospectively-collected data of people undergoing primary elective THA or TKA for osteoarthritis across 19 hospitals was performed. We assessed outcomes at 1 year post-surgery for people with and without medically treated anxiety and/or depression at the time of surgery (A/D and no-A/D). We used unadjusted and adjusted analyses to compare improvement in Oxford Hip or Knee Scores, the incidences of major post-operative complications, satisfaction and index joint improvement by A/D status. Results: 15.2% (254/1669) of patients were identified with anxiety and/or depression at time of surgery. In the unadjusted analysis, the A/D group had greater mean Oxford score improvement by 2.1 points (95% CI 0.8 to 3.4, p = 0.001), increased major complications (OR 1.39, 95% CI 1.05 to 1.85, p = 0.02), were less likely to report a “much better” global improvement for index joint (OR 0.56, 95% CI 0.38 to 0.83, p = 0.003), and there was no statistically significant difference in the rate of satisfaction with the results of surgery (OR 0.64, 95% CI 0.37 to 1.10, p = 0.10). The adjusted analysis found no significant associations between A/D vs. no-A/D and any of the reported outcomes. Conclusion: After adjustment for confounding variables, people with anxiety and/or depression pre-operatively, compared to those without, have similar outcomes following hip or knee arthroplasty.

Does psychological distress influence postoperative satisfaction and outcomes in patients undergoing total knee arthroplasty? A prospective cohort study

“…This may be due to the low awareness rates, diagnostic rates, and treatment rates of mental disorders in Chinese patients [ 22 ]. Additionally, we found that a higher proportion of women were present in the distressed group than in the non-distressed group, which was similar to that in previous studies [ 23 , 24 ]. However, the proportion of women was relatively high in our study; the reason for that remains unknown and further investigation may be needed.…”

Influence of Depression and Sleep Quality on Postoperative Outcomes after Total Hip Arthroplasty: A Prospective Study

“…The authors concluded that patients should be treated for depressive symptoms pre-and postoperatively to maximize THA outcomes. The results of this study are similar to those of the present study, despite the use of a different categorization approach for mental health conditions [33]. The strength of utilizing psychiatrist-diagnosed patients instead of a self-scored questionnaire such as the GDS would be the precision and accuracy of medical diagnosis.…”

“…Seagrave et al explored the association between depression (diagnosed by a psychiatrist) treated with medication and outcomes of THA one year postoperatively [33]. Anxiety and depression groups experienced a greater improvement in the Oxford Hip Score, while there was a less global joint improvement, and they were more likely to have major complications.…”

UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): what does analysis of linked, routinely collected national data sets tell us about mid-late term revision risk after hip replacement? Retrospective cohort study

“…Also, our study found an association between antidepressant use prior to primary surgery and increased risk of revision; however, we did not find that patient levels of anxiety and depression recorded in preoperative PROMS were a risk factor. In another study of hip and knee replacement, use of antidepressant medication preoperatively did not affect outcomes 1 year postsurgery, 31 but the effect on mid-late term revision was not discussed.…”