IOA 2022

Pre-Operative Depression is Not Associated with Inferior Outcomes following Total Hip Arthroplasty

Connor Byrne Caleb Durst Kevin Rezzadeh Zachary Rockov Karma McKelvy Andrew Spitzer Sean Rajaee
Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, USA

Introuction:
Preexisting depression negatively impacts outcomes following total hip arthroplasty (THA). Patient Reported Outcomes Measurement Information System (PROMIS) surveys are validated measures which quantify depression, pain, and physical function. We hypothesized that higher levels of preoperative PROMIS depression scores were associated with inferior outcomes following THA.

Methods:
248 patients underwent primary total hip arthroplasty at the same institution by three fellowship trained arthroplasty surgeons between June 2018 and August 2020. PROMIS scores were collected preoperatively and at 6 weeks, 3 months, 1 and 2 years postoperatively. Patients with preoperative PROMIS depression scores ≥ 55 were considered depressed. The primary outcome measures were changes in PROMIS scores over time. Secondary outcomes were total (TME) and mean per day morphine equivalent (MME) usage during admission, 90-day hospital readmission, and revisions within two years.

Results:
79 patients had preoperative PROMIS depression scores >55 (Depressed) and 169 were not depressed (ND). Depressed patients were significantly younger than ND (60.8 vs 65.9, p=0.01) and had significantly higher levels of MMEs while hospitalized (73.0 vs 54.9, p=0.038). Depressed patients used numerically higher TME (218.6 vs. 161.6, p=0.247). Depressed patients had significantly lower preoperative PROMIS scores for pain (p<0.001) and function (p<0.001). [Figure 1] Depressed patients had significantly improved depression PROMIS scores at all follow-up intervals (p<.01). All other changes in PROMIS pain and function scores were not significantly different between groups [Figure 2, 3]. There were no significant differences in hospital readmissions or revisions between the groups [Figure 4].

Discussion:
Preoperative PROMIS depression scores > 55 do not negatively impact postoperative function, depression, or pain following THA, and are associated with greater improvement in depression. There also is not a higher rate of revisions or readmissions. Depression was not associated with inferior outcomes following THA in this study.