Preoperative Depression is Not Associated with Inferior Outcomes following Total Hip Arthroplasty

Abstract

AbstractPreexisting 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. A total of 247 patients underwent primary THA at the same institution by three arthroplasty surgeons between June 2018 and August 2020. PROMIS scores were collected preoperatively and at 6 weeks, 3 months, and 1 year postoperatively. Patients with preoperative PROMIS depression scores of 55 or more were considered depressed. The primary outcome measures were changes in PROMIS scores over time. Secondary outcomes were total morphine milligram equivalent (TME) and mean morphine equivalents per day (MME) received during admission, 90-day emergency room visits and hospital readmissions, and revisions within 2 years. Seventy-eight patients had preoperative PROMIS depression scores of 55 (PD) or more and 169 were not depressed (ND). PD patients were younger (PD: 62.0 [14.3] vs. ND: 66 [11.7], p = 0.028) at time of surgery and had higher TME (PD: 211.5 [320.9] vs. ND: 161.5 [375.9], p = 0.022) and MME (PD: 78.0 [71.6] vs. ND: 59.1 [67.3], p = 0.005) usage during hospitalization compared to ND patients. PD patients had higher preoperative PROMIS scores for pain (p < 0.001) and lower scores for function (p < 0.004). PD patients had improved PROMIS depression scores at all follow-up intervals (p < 0.01). All other changes in PROMIS pain and function scores were not different between groups. There were no significant differences in readmission rates or patients requiring revisions. Preoperative PROMIS depression scores of 55 or more 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.