Psychological factors as risk factors for poor hip function after total hip arthroplasty

Abstract

Recovery after total hip arthroplasty (THA) is influenced by several psychological aspects, such as depression, anxiety, resilience, and personality traits. We hypothesized that preoperative depression impedes early functional outcome after THA (primary outcome measure). Additional objectives were perioperative changes in the psychological status and their influence on perioperative outcome. This observational study analyzed depression, anxiety, resilience, and personality traits in 50 patients after primary unilateral THA. Hip functionality was measured by means of the Harris Hip Score. Depression, state anxiety, and resilience were evaluated preoperatively as well as 1 and 5 weeks postoperatively. Trait anxiety and personality traits were measured once preoperatively. Patients with low depression and anxiety levels had significantly better outcomes with respect to early hip functionality. Resilience and personality traits did not relate to hip functionality. Depression and state anxiety levels significantly decreased within the 5-week stay in the acute and rehabilitation clinic, whereas resilience remained at the same level. Our study suggests that low depression and anxiety levels are positively related to early functionality after THA. Therefore, perioperative measurements of these factors seem to be useful to provide the best support for patients with risk factors.

Keywords: depression; personality traits; psychological factors; resilience; state anxiety; total hip arthroplasty; trait anxiety.

Figure 1

Flowchart of study design. Note: ADS-L is the German version of the Center for Epidemiological Studies Depression Scale. Abbreviations: T0, prior to surgery; T1, 1 week after surgery; T2, 5 weeks after surgery.

Figure 2

Influence of depression on hip functionality (Harris Hip Score); the lower the depression score, the better hip functionality is. Abbreviations: T0, prior to surgery; T1, 1 week after surgery; T2, 5 weeks after surgery.

Figure 3

Influence of anxiety on hip functionality (measured by means of Harris Hip Score). Abbreviations: T0, prior to surgery; T1, 1 week after surgery; T2, 5 weeks after surgery.