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Psychiatric and Somatic Sequelae After Total Hip Arthroplasty in Patients With Major Depressive Disorder: A
Muaz Wahid1, Zuhair Zaidi, Elias Nasser
1From the Medical Student at UT Southwestern Medical School, Dallas, TX (Wahid, Zaidi, and Nasser), and Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX (Meza and Chen).
Introduction:
This study evaluated whether major depressive disorder (MDD), a common comorbidity affecting outcomes after total hip arthroplasty (THA), is independently associated with new-onset psychiatric and somatic morbidity.
Methods:
Adults undergoing primary THA (2015-2024) were identified from a multi-institutional database, excluding patients with prior hip pathology or psychiatric diagnoses other than MDD. Propensity score-matched cohorts were compared at 90 days and 1 year using odds ratios (OR) with 95% confidence intervals (CI).
Results:
After exclusions, 5,864 patients with MDD and 144,640 control subjects were identified, yielding 3,412 matched pairs. P < 0.001 unless otherwise noted. MDD was associated with significantly higher odds of new-onset psychiatric disorders at 90 days and 1 year, including generalized anxiety disorder (OR90d, 22.48: 95% CI, 14.6-34.5; OR1yr, 16.53: 95% CI, 12.0-22.8), adjustment disorder (OR90d, 5.81: 95% CI, 3.9-8.6; OR1yr, 5.40: 95% CI, 3.9-7.4), posttraumatic stress disorder (OR90d, 4.14: 95% CI, 2.8-6.1; OR1yr, 7.33: 95%, CI 5.4-9.9), schizophrenia (OR90d, 2.21: 95% CI, 1.1-4.6: P = 0.03; OR1yr, 2.22: 95% CI, 1.3-3.8: P = 0.002), alcohol use disorder (OR90d, 3.73: 95% CI, 2.6-5.4; OR1yr, 2.61: 95% CI, 1.9-3.6), opioid use disorder (OR90d, 2.31: 95% CI, 1.2-4.3: P = 0.02; OR1yr, 2.69: 95% CI, 1.7-4.2), dementia (OR90d, 12.24: 95% CI, 8.2-18.3; OR1yr, 9.27: 95% CI, 6.6-13.0), and suicide (OR1yr, 6.71: 95% CI, 3.7-12.0). Somatic risks included mortality (OR90d, 2.26: 95% CI, 1.1-4.5: P = 0.02; OR1yr, 1.96: 95% CI, 1.4-2.7), chest pain (OR90d, 1.74: 95% CI, 1.3-2.3; OR1yr, 1.25: 95% CI, 1.1-1.5, P = 0.007), shortness of breath (OR90d, 1.28: 95% CI, 1.0-1.7: P = 0.0498; OR1yr, 1.28: 95% CI, 1.1-1.5, P = 0.002), dizziness (OR1yr, 1.49: 95% CI, 1.2-1.8), and postoperative emergency department visits (OR1yr, 1.27: 95% CI, 1.1-1.5).
Conclusion:
In patients with isolated MDD, the condition independently increased psychiatric, cognitive, somatic, and mortality risks after THA.
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