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Should Depression Be Treated Before Lower Extremity Arthroplasty?

Thomas K Fehring1, Susan M Odum2, Brian M Curtin1

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Preoperative depression in arthroplasty patients significantly improves after surgery. Patients with preoperative depressive symptoms achieve similar outcomes to non-depressed patients, suggesting depression screening shouldn't prevent surgery.

Keywords:
PHQ-9depressionjoint arthroplastyoptimizationpatient

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Area of Science:

  • Orthopedic Surgery
  • Psychological Medicine
  • Health Outcomes Research

Background:

  • Patient optimization before arthroplasty is crucial for successful outcomes.
  • Depression is a potential modifiable risk factor requiring preoperative assessment.
  • The impact of psychological interventions on surgical outcomes needs further investigation.

Purpose of the Study:

  • To determine the prevalence of preoperative depression in arthroplasty patients.
  • To assess the improvement of depressive symptoms post-surgery.
  • To evaluate the association between preoperative depression and postoperative outcomes.

Main Methods:

  • Patients completed the Patient Health Questionnaire (PHQ-9) pre- and post-operatively.
  • Depression severity was assessed using PHQ-9 scores.
  • Postoperative functional outcomes were measured using Hip Disability and Osteoarthritis Outcome Score and Knee Injury and Osteoarthritis Outcome Score.

Main Results:

  • A significant improvement in depressive symptoms was observed post-arthroplasty.
  • Patients with moderate to severe preoperative depression showed substantial symptom reduction.
  • Preoperative depression did not significantly impact final functional outcome scores.

Conclusions:

  • Arthroplasty effectively diminishes pain and improves function, leading to significant depression symptom improvement.
  • Preoperative depression does not appear to negatively affect postoperative outcomes.
  • Depression screening thresholds should not be used to deny patients surgical intervention.