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Preoperative psychiatric diagnosis predicts functional failure and dissatisfaction after total hip arthroplasty: a
Shujaa T Khan1, Benjamin E Jevnikar1, Khaled A Elmenawi1
1Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, USA.
Background:
Psychiatric comorbidities are increasingly prevalent among patients undergoing total hip arthroplasty (THA), yet their impact on clinically meaningful outcomes remains underexplored. This study evaluates the association between preoperative psychiatric diagnoses and patient-reported outcomes (PROMs), satisfaction, and healthcare utilization following THA.
Methods:
A retrospective cohort of 11,766 patients undergoing primary elective unilateral THA between 2016 and 2022 across a multisite academic center was analyzed. Psychiatric diagnoses were identified via ICD-9/10 codes within 2 years preoperatively. PROMs were collected at baseline and 1 year postoperatively, including HOOS Pain, HOOS Physical Function Shortform (PS), HOOS Joint Replacement (JR), and VR-12 Mental Component Score (MCS). Outcomes included failure to achieve minimal clinically important difference (MCID), failure to reach patient acceptable symptom state (PASS), dissatisfaction, non-home discharge, prolonged length of stay (LOS ≥ 2 days), and 90-day readmission. Multivariable logistic regression adjusted for demographic and clinical covariates.
Results:
Psychiatric diagnoses were present in 26.1% of patients. Psychiatric illness was associated with failure to achieve MCID in HOOS Pain (OR 1.43), HOOS PS (OR 1.31), and HOOS JR (OR 1.54), as well as failure to reach PASS thresholds (all p < 0.001). Patients with psychiatric diagnoses had increased odds of dissatisfaction (OR 1.34), non-home discharge (OR 1.36), prolonged LOS (OR 1.24), and readmission (OR 1.54). Subgroup analysis demonstrated a dose-dependent relationship, with multiple psychiatric diagnoses conferring the highest risk of poor outcomes.
Conclusion:
Preoperative psychiatric illness is an independent predictor of suboptimal functional outcomes, lower satisfaction, and increased healthcare utilization after THA. These findings highlight the need for psychiatric screening and optimization during the preoperative period to improve outcomes in this high-risk population.
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