Joint replacement complications may be affected by pre-surgery depression and anxiety

Danielle.Steilen.ProlotherapistDanielle R. Steilen-Matias, PA-C

Doctors at the Rothman Institute at Thomas Jefferson University looked for reasons to explain complications following total joint replacement (arthroplasty).

They found that surgical outcome may be affected by numerous factors including pre-surgery depression and/or anxiety which clearly were isolated as causes of increased complications after total joint replacement.

Therefore, they concluded, patients with depression or anxiety undergoing joint replacement need to be counselled appropriately, and all efforts need to be invested to minimize complications.1

Depression before joint replacement, depression after joint replacement

In May 2017 issue of the prestigious British Journal of Surgery, researchers at the  University of Manchester wrote about patients who underwent hip replacements, knee replacements, hernia repairs, varicose vein operations.

It is somewhat assumed that a patient with significant joint pain will have a happy disposition once that knee pain is alleviated to their, the patient’s, satisfaction. This is not the case for many patients. Now doctors are trying to figure out the cause and effect and one thing they are finding is that joint replacement does not reduce mental health concerns.

New research in the medical journal Aging and Mental Health says: “Total Joint Replacement patients did not show any clinically meaningful reductions in symptoms of depression or anxiety, following surgery.3

Doctors in Denmark all suggest that patients with psychiatric disorders tend to do worse than patients without a psychiatric diagnosis when undergoing total hip arthroplasty (replacement) or total knee arthroplasty (replacement).

Whether this is due to their psychiatric condition, pharmacological treatment, a combination of the two, or something else has not been thoroughly analyzed-and there are no internationally accepted guidelines for perioperative management of psychiatric patients.4

Doctors in Serbia examined factors associated with severe postoperative pain in patients with total hip replacement. Patients with severe anxiety, depression and Type D personality (tendency to worry or lack self-assurance)  appear to be at risk of developing severe postoperative pain. In addition, being female and the intensity of pain immediately after procedure were found to be important risk factors as well.5

In the medical journal Pain, doctors found a significant connection between postsurgical anxiety and acute pain and this was confirmed by showing the relevance of psychological factors, over and above other potential clinical predictors that may lead to excessive or acute pain after surgery. It was recommended that doctors should target interventions aimed at acute postsurgical pain and anxiety management following major joint replacement.6

A multi-national study including doctors from the US, Germany, and Sweden found that 10% of patients in their study used antidepressants and these patients had poorer Quality of Life  and higher levels of pain before and after surgery. The study concluded preoperative antidepressant use was independently associated with low patient reported outcomes one year after total hip replacement. Clinicians are encouraged to screen for antidepressant use preoperatively.7

As shown in the literature anxiety and depression are key factors in preventing patients from healing. We cover this subject further in these articles

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1 Rasouli MR, Menendez ME, Sayadipour A1 Purtill JJ, Parvizi J. Direct Cost and Complications Associated With Total Joint Arthroplasty in Patients With Preoperative Anxiety and Depression.J Arthroplasty. 2016 Feb;31(2):533-6. [Pubmed] [Google Scholar]

2 Britteon P, Cullum N, Sutton M. Association between psychological health and wound complications after surgery. Br J Surg. 2017 May;104(6):769-776. doi: 10.1002/bjs.10474. [Pubmed] [Google Scholar]

3 Scott JE, Mathias JL, Kneebone AC. Depression and anxiety after total joint replacement among older adults: a meta-analysis.  Aging Ment Health. 2016 Dec;20(12):1243-1254. [Pubmed] [Google Scholar]

4 Gylvin SH, rgensen CC, Fink-Jensen A, Kehlet H. Psychiatric disease as a risk factor in fast-track hip and knee replacement. Acta Orthop. 2016 Oct;87(5):439-43. doi: 10.3109/17453674.2016.1151292. Epub 2016 Feb 22 [Pubmed] [Google Scholar]

5 Petrovic NM, Milovanovic DR, Ignjatovic Ristic D, Riznic N, Ristic B, Stepanovic Z. Factors associated with severe postoperative pain in patients with total hip arthroplasty. Acta Orthop Traumatol Turc. 2014;48(6):615-22. [Pubmed] [Google Scholar]

6 Pinto PR, McIntyre T, Ferrero R, Almeida A, Araújo-Soares V. Predictors of acute postsurgical pain and anxiety following primary total hip and knee arthroplasty. J Pain. 2013 May;14(5):502-15. [Pubmed] [Google Scholar]

7 Greene ME, Rolfson O, Gordon M, Annerbrink K, Malchau H, Garellick G. Is the use of antidepressants associated with patient-reported outcomes following total hip replacement surgery? Acta Orthop. 2016 Oct;87(5):444-51. [Pubmed] [Google Scholar]

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