EFFECT OF PREOPERATIVE SELF-REPORTED ANXIETY AND/OR DEPRESSION ON PATIENT-REPORTED OUTCOMES IN HIP AND KNEE ARTHROPLASTY PATIENTS

Hip and knee replacements are among the most effective treatments for degenerative joint conditions. Patient-reported outcome measures (PROMs) are essential to a person-centred approach to health care, providing the patients’ perspective on aspects of their health status. Pain, anxiety and depression are important to consider as they are associated with poorer outcomes yet are potentially modifiable. This work aims to examine the relationship of self-reported pre-operative anxiety and/or depression with PROMs one year after a hip or knee replacement. PROMs, including Oxford Hip/Knee Scores (OHS/OKS), EQ-5D-5L and post-operative satisfaction, were completed by patients who had a primary, elective, unilateral hip or knee replacement between 2018 and 2022. Demographic characteristics and self-reported outcomes at 12 months (functional status, pain, and satisfaction) were compared between patients reporting any problems with anxiety and/or depression before surgery versus no problems as measured by the EQ-5D-5L. Differences in baseline characteristics (age, sex) were accounted for when comparing the effect of mental health concerns on outcomes. A total of 3,326 hip and 3,730 knee replacement patients completed PROMs before and one year after surgery. Before surgery, 60% and 55% of hip and knee replacement patients reported some level of anxiety and/or depression. We observe that patients with anxiety and/or depression are at a higher risk of poorer self-reported functional status before and after surgery, but the average improvement in their Oxford score is slightly higher than those without anxiety and/or depression. The proportion of patients who reached a minimal clinically important difference (based on Deckey et al.) are also similar between patients with mental health concerns versus without (hip: 92% vs. 91%; knee 88% vs. 86%). Patients with anxiety and/or depression are also at a higher risk of having problems with pain a year after surgery than patients without mental health concerns (hip OR: 1.82, p=< .0001; knee OR: 1.55, p=< .0001). Five percent or less of patients reported worsened pain for both groups. Finally, anxiety and/or depression is also a predictor of feeling neutral or dissatisfied with a patient's surgical results (hip OR: 1.51, p=0.003; knee OR: 1.56, p=< .0001). These relationships were observed in both hip and knee patient groups. We found that patients who reported feeling anxious and/or depressed before surgery are likely to attain similar improvement in self-reported functional outcomes compared to patients without psychological concerns. Further investigation is needed to understand why patients having anxiety and/or depression were more likely to be dissatisfied with their surgical results. A limitation of this analysis is the lack of data on patient expectations, which has been shown to be a predictor of satisfaction. Selection bias cannot be discounted as it may be possible that patients who attain better functional outcomes are more likely to complete PROMs post-operatively. These results demonstrate the need to address mental health concerns for these patients (e.g., pre-operative counselling on expectation setting and the impact of anxiety and/or depression on perceived functional gains) to improve satisfaction with surgery and outcomes.