gms | German Medical Science

Objectives: The objective of this study was to assess psychosocial well-being (anxiety, depression, pain-catastrophizing) before and one year after total joint replacement by use of different patient-reported outcome measures (PROMs).

Methods: This prospective cohort study included 458 patients with osteoarthritis of the hip or knee undergoing total joint replacement (253 THA, 205 TKA). All patients completed a booklet of different PROMs preoperatively, and at 3, 6 and 12 months after surgery, respectively. Following PROMs were used: Oxford Hip or Knee Score (OHS, OKS), Euroqol-5 dimension (EQ-5D), UCLA activity scale, Hospital Anxiety and Depression Scale (HADS) and Pain Catastrophizing Scale (PCS). Additional questions regarding satisfaction (patient acceptable symptom state (PASS) were assessed at 12 months. Statistical analyses included descriptive results (PROMs score changes), correlations between HADS and PCS with the function-related PROMs, and regression analyses to determine the predictive value of anxiety, depression and pain catastrophizing on functional scores and satisfaction at 12 months after surgery.

Results: All PROMs significantly improved after surgery and achieved the highest scores at 12 months. HADS and PCS scores were consistently moderately correlated with OHS/OKS, EQ-5D and UCLA scores at all time points. Overall, 14.4% and 8.3% of the THA patients had anxiety and depression preoperatively which decreased to 4.2% and 2.1% at 12 months after surgery. For TKA, the proportions were 16.6% (anxiety) and 12.3% (depression) at baseline, and decreased to 4.7% and 4% at last follow-up. Pain catastrophizing was detected in 7.3% of the hip patients and 6.6% of the knee patients before surgery, at 12 months 2.1% and 2.7% respectively. Binary logistic regression showed that higher PCS scores decreased the chance of being satisfied with the current state and the operation in TKA and THA patients. Multiple regression analysis showed that patients experiencing depression and pain catastrophizing at baseline had worse OKS and OHS scores at 12 months.The pattern of changes in the OHS and OKS scores over time was similar between patients with or without anxiety, depression or pain catastrophizing. The significant differences after 12 months (lower values in patients with psychological distress) remained after adjusting the follow up scores for the baseline imbalance suggesting a real lower perceived benefit of joint replacement.

Conclusion: The present results show that anxiety, depression and pain catastrophizing are correlated with the results of total joint replacement. Overall, the proportion of osteoarthritis patients with psychosocial distress was relatively low for both THA and TKA, and this proportion fortunately further decreased after surgery. Nevertheless, higher levels of psychosocial distress at baseline can predict less favorable outcomes of total joint replacement as measured by PROMs and subjective satisfaction ratings one year after surgery.