Low preoperative mental health scores, regardless of diagnosed depression or anxiety, are associated with worse short-term clinical outcomes following unilateral total hip arthroplasty, emphasizing the need to consider overall mental health indicators in predicting postoperative complications.
1. In this retrospective cohort study, patients who underwent total hip arthroplasty (THA) who had global mental health (GMH) scores in the lowest quartile had worse outcomes, including being less likely to be discharged home, than those with GMH scores in the top quartile.
2. However, patients in the lowest GMH quartile had greater improvements in GMH and global physical health (GPH) scores following the surgery compared to those in the top quartile.
Evidence Rating Level: 3 (Average)
Factors such as obesity and diabetes are known to influence clinical outcomes following total joint arthroplasty. Prior research has suggested that preoperative mental health could be another predictor of clinical outcomes, with studies finding that those with depression are at an increased risk of postoperative complications and pain. However, most studies to date have focused on diagnoses of depression and anxiety, which fails to consider the impact on patients with undiagnosed mental health concerns or low overall mental health. Thus, the present study aimed to assess the relationship between preoperative mental health scores and clinical outcomes in patients who underwent unilateral total hip arthroplasty (THA).
This retrospective cohort study included 142 patients who underwent primary unilateral THA. Patients were included if they were under 80 and underwent THA for osteoarthritis. Participants were excluded if they underwent THA for femoral neck fractures or required additional procedures, such as hardware removal in addition to their primary THA procedure. Furthermore, patients with bipolar disorder, schizophrenia, chronic pain conditions requiring narcotic use for more than six weeks prior to surgery, or a history of substance abuse were excluded. The Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR), and Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were conducted before the surgery and at the six-week postoperative clinic visit. Furthermore, the global physical health (GPH) and global mental health (GMH) scores were evaluated. The primary outcome was the association between preoperative GMH scores and postoperative outcomes.
The results demonstrated that those with preoperative GMH scores in the lowest quartile had worse postoperative outcomes, including being less likely to be discharged home and lower GPH, GMH, and HOOS JR scores at the 6-week follow-up, than those with GMH scores in the top quartile. However, patients in the lowest quartile for preoperative GMH scores had a greater improvement in GPH and GMH scores compared to those in the highest quartile. Furthermore, there were no differences in clinical outcomes between those with and without a diagnosis of depression and anxiety, highlighting the importance of focusing not only on a mental health diagnosis but also on indicators of low mental health when considering the risk of postoperative complications. However, the study was limited by the short 6-week follow-up period, which did not allow for the investigation of long-term effects. Nonetheless, the present study demonstrated how low mental health can impact clinical outcomes following THA.
Click to read the study in Archives of Orthopaedic and Trauma Surgery
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