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Mental Health Effects on the Minimal Clinically Important Difference in Total Joint Arthroplasty
Mehdi S Salimy1, Aris Paschalidis, Jacquelyn A Dunahoe
1From the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School (Salimy, Paschalidis, Dunahoe, Alpaugh, Bedair, and Melnic), the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Chen), and the Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA (Bedair, and Melnic).
Mental health diagnoses negatively impact outcomes for primary total hip arthroplasty patients. Revision total joint arthroplasty patients showed poorer results, independent of mental health status.
Area of Science:
- Orthopedic Surgery
- Mental Health Research
- Patient Outcomes
Background:
- The impact of mental health on patient-reported outcomes in total joint arthroplasty (TJA) requires further investigation.
- Understanding this relationship is crucial for optimizing patient care and recovery.
Purpose of the Study:
- To examine the association between mental health diagnoses (MHDs) and the achievement of Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W) in primary and revision TJA.
- To differentiate the influence of MHDs on outcomes in primary total hip arthroplasty (pTHA), primary total knee arthroplasty (pTKA), and revision TJA (rTJA).
Main Methods:
- Retrospective analysis of 4,562 TJA patients, including primary and revision cases.
- Utilized Current Procedural Terminology and International Classification of Diseases, 10th Revision codes to identify MHDs.
- Assessed patient-reported outcomes using validated questionnaires like HOOS, KOOS, and PROMIS, analyzing MCID-I and MCID-W rates via logistic regression.
Main Results:
- Mental health diagnoses were associated with significantly lower MCID-I rates and higher MCID-W rates in primary total hip arthroplasty patients across multiple outcome measures.
- Primary total knee arthroplasty patients with MHDs showed a reduced likelihood of achieving MCID-I for physical function.
- No significant effect of MHDs on MCID-I or MCID-W was observed in the revision total joint arthroplasty cohort.
Conclusions:
- Mental health diagnoses exert a substantial negative influence on patient-reported outcomes, particularly in primary total hip arthroplasty.
- Revision TJA patients experienced poorer outcomes regardless of mental health status, highlighting distinct challenges in this group.
- Further research into managing mental health comorbidities in TJA patients is warranted to improve functional recovery and patient satisfaction.
