Depression Is Transiently Increased in Patients Undergoing Two-Stage Revision Arthroplasty

Area of Science:

• Orthopedic Surgery
• Mental Health
• Arthroplasty Outcomes

Background:

• Mental health implications of two-stage revision arthroplasty remain unclear.
• Prosthetic joint infection necessitates two-stage revision, impacting patient well-being.
• Assessing depression in patients undergoing revision hip and knee arthroplasty is crucial.

Purpose of the Study:

• To compare Patient-Reported Outcomes Measurement Information System (PROMIS) Depression scores between two-stage and aseptic revision arthroplasty patients.
• To determine if patients undergoing two-stage revision are more likely to have scores consistent with major depressive disorder (MDD).
• To evaluate the resolution of depression symptoms after revision arthroplasty procedures.

Main Methods:

• Retrospective review of 366 revision total hip or knee arthroplasty cases (Jan 2015 - June 2019).
• Exclusion of 42 patients with incomplete data or missing PROMIS Depression scores.
• Collection of preoperative, early postoperative, and final postoperative PROMIS Depression scores; evaluation against the MDD threshold (PHQ-9 ≥10).

Main Results:

• 20.0% of two-stage revision patients developed MDD-indicative Depression scores versus 6.5% in the aseptic cohort (P=.01).
• Two-stage revision patients had higher median preoperative and early postoperative Depression scores (P=.04 and P=.01, respectively).
• Depression scores improved significantly across both cohorts by final follow-up (P<.001).

Conclusions:

• A significant proportion of two-stage revision patients (20%) exhibit depression scores consistent with MDD during treatment.
• Aseptic revision patients showed a lower incidence of MDD-indicative depression scores (<7%).
• Clinically significant improvements in depression were observed in both patient groups by the final follow-up assessment.