Efficacy and risk factors for anxiety and depression after mini-incision hip arthroplasty for femoral head osteonecrosis

Abstract

Background: Osteonecrosis of the femoral head (ONFH) is a prevalent orthopedic issue, leading to the collapse and fragmentation of the femoral head in its advanced stages, which can severely impair patients' quality of life. Total hip arthroplasty (THA) is a clinical intervention frequently used to alleviate ONFH symptoms and reinstate hip functionality. The conventional surgical technique is invasive and comes with an extended recuperation period, posing significant challenges for patients. With the progression of medical technology, the use of the mini-incision technique in minimally invasive THA (MITHA) has become more prevalent. However, comparative studies examining the effectiveness of these two surgical procedures in treating ONFH remain scarce. Furthermore, understanding patients' psychological well-being is crucial given its profound influence on postoperative recuperation.

Aim: To evaluate the impact of mini-incision MITHA on ONFH treatment and to identify the risk factors associated with postoperative anxiety and depression.

Methods: A retrospective study was conducted on 125 patients treated for ONFH at Xi'an Hong Hui Hospital between February 2020 and January 2022, with the term "consecutive" indicating that these patients were treated in an unbroken sequence without any selection. Among these, 60 patients (control group) underwent traditional THA, while 65 patients (observation group) were treated with mini-incision MITHA. Variations in the visual analog scale (VAS) score and the Harris hip score were monitored. Additionally, shifts in pre- and posttreatment Hamilton anxiety (HAMA) and Hamilton depression (HAMD) scale scores were recorded. Patients with both postoperative HAMA and HAMD scores of ≥ 8 were identified as those experiencing negative emotions. Logistic regression was utilized to analyze the determinants influencing these negative emotional outcomes. Comparative analyses of surgical and postoperative metrics between the two groups were also conducted.

Results: Posttreatment results indicated a significantly higher VAS score in the control group than in the observation group, while the Harris score was considerably lower (P < 0.0001). The observation group benefited from a notably shorter operation duration, reduced blood loss, diminished incision size, and a decreased postoperative drainage time (P < 0.0001), accompanied by a reduced hospital stay and lower treatment costs (P < 0.0001). The control group had elevated posttreatment HAMA and HAMD scores in comparison to the observation group (P < 0.0001). Multivariate logistic regression revealed that being female [odds ratio (OR): 4.394, 95%CI: 1.689-11.433, P = 0.002], having a higher postoperative VAS score (OR: 5.533, 95%CI: 2.210-13.848, P < 0.0001), and having higher treatment costs (OR: 7.306, 95%CI: 2.801-19.057, P < 0.0001) were significant independent determinants influencing postoperative mood disturbances.

Conclusion: Compared to conventional THA, mini-incision MITHA offers advantages such as reduced operation time, minimal bleeding, and a shorter incision in ONFH patients. Moreover, factors such as sex, postoperative pain (reflected in the VAS score), and treatment costs significantly impact postoperative anxiety and depression.

Keywords: Anxiety; Depression; Minimally invasive total hip arthroplasty; Necrosis of the femoral head; Postoperative recovery; Total hip arthroplasty.

Figure 1

Changes of visual analogue scales and Harris hip score scores in patients before and after treatment. A: Comparison of visual analogue scales score; B: Comparison of Harris hip score; VAS: Visual analogue scales. ^dP < 0.0001.

Figure 2

Comparison of surgical indexes. A: Comparison of operation time; B: Comparison of intraoperative blood loss; C: Comparison of incision length; D: Comparison of postoperative drainage time. ^dP<0.0001.

Figure 3

Comparison of postoperative indexes. A: Comparison of length of stay; B: Comparison of treatment cost. ^dP<0.0001.

Figure 4

Changes of Hamilton anxiety scale and Hamilton depression scale scores before and after treatment. A: Comparison of Hamilton anxiety scale score; B: Comparison of Hamilton depression scale score. HAMA: Hamilton anxiety scale; HAMD: Hamilton depression scale. ^dP<0.0001.