New research suggests prior mental health conditions can affect the recovery from total joint replacement surgery.
Two new studies, presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), suggest understanding an individual’s mental health status is an important factor for achieving the best outcome after surgery.
The knowledge is meaningful for obtaining improved clinical and generic (patient-satisfaction) outcomes — two measures that will influence future reimbursement schedules for surgeons.
One paper, derived from a study of 97 men and women who received minimally invasive total knee replacement (TKR) surgery, suggested men with anxiety traits — defined as a high level of anxiety unrelated to a stressful event — had higher post-operative pain ratings resulting in longer hospital stays. Women were found to generally report higher post-operative pain levels than men, and women were consistently less satisfied with pain control.
However, researchers found that some old presumptions did not hold up to the new findings. Specifically, postoperative pain or pain medication use in either men or women was not linked to reports of anxiety or even “catastrophizing” (an extreme response to stress).
In the next paper, reporting on a study of 1,657 patients receiving hip replacement surgery, researchers discovered patients taking antidepressants up to three years prior to undergoing a total hip replacement (THR) were more likely to report greater pain before and after surgery and less satisfaction with their procedure.
Approximately 215 patients were using antidepressants three years before the surgery.
In this study, patients were surveyed before and one year after the THR. The investigators found that a patient’s mental health status, assessed by the use of antidepressants before surgery, was a significant factor in predicting outcomes, as well as gender (men are more likely to report lower outcomes), advanced age and co-morbidity (other joint diseases or conditions which affect walking).
In summary, researchers believe a patient’s mental health status should be assessed prior to surgery and taken into consideration during post-operative care.