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. 2025 Jun 9:S0883-5403(25)00672-2.
doi: 10.1016/j.arth.2025.06.013. Online ahead of print.

Anxiety and Depression Symptoms Are Associated With Inferior Outcomes in Patients Undergoing Total Hip Arthroplasty: A Prospective Cohort Study

Margot B Aalders  1 , Mike J P Ligthart  2 , Olivier P P Temmerman  3 , Joyce L Benner  4 , Jelle P van der List  2 , Gino M M J Kerkhoffs  5 , Lucien C M Keijser  3
Affiliations

Anxiety and Depression Symptoms Are Associated With Inferior Outcomes in Patients Undergoing Total Hip Arthroplasty: A Prospective Cohort Study

Margot B Aalders et al. J Arthroplasty. .

Abstract

Background: The aim was to assess the association between preoperative anxiety and depression symptoms and subjective function, pain, quality of life, and revision rates after total hip arthroplasty (THA).

Methods: This prospective study included 1,260 patients undergoing THA between January 2019 and June 2022. Patients completed the Hospital Anxiety and Depression Scale preoperatively and a set of Patient-Reported Outcome Measures (PROMs) preoperatively and at 3, 12, and 24 months postoperatively. Patients were categorized into anxiety/nonanxiety and depression/nondepression groups based on Hospital Anxiety and Depression Scale scores. The PROMs included the Hip disability and Osteoarthritis Outcome Score-Physical Function Shortform, Oxford Hip Score, Numeric Rating Scale for Pain, and quality of life (EuroQol five-dimensional questionnaire, EQ-5D-5L). Differences between groups were assessed, including minimal clinically important differences and attainments of Patient Acceptable Symptom State. Length of hospital stay and revision rates were also compared.

Results: Patients who had preoperative anxiety and depression symptoms had worse function, pain, and quality of life preoperatively and up to 2 years postoperatively (all P < 0.014). In multivariate regression, preoperative anxiety and depression remained independently associated with worse postoperative outcomes. Anxiety and depression patients were less likely to reach the Patient Acceptable Symptom State for all PROMs up to 2 years postoperatively (all P ≤ 0.027) and had longer lengths of hospital stays (P < 0.001). Contrastingly, they showed greater improvements for all PROMs, with higher proportions reaching minimal clinically important differences for EQ-5D-5L (all P < 0.001). Revision rates did not differ (P ≥ 0.163).

Conclusions: Anxiety and depression symptoms were independently associated with worse postoperative subjective function, pain, and quality of life after THA and longer hospital stays. This reinforces the role of psychological factors in surgical recovery. While these patients experience major clinical improvement after THA, their recovery trajectories differ, emphasizing the need for tailored perioperative counseling and psychological support.

Keywords: Hospital Anxiety and Depression Scale; anxiety; depression; psychological factors; total hip arthroplasty.

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