The Association of Preoperative Patient Resilience With Postoperative Patient-Reported Outcomes Following Total Joint...

Total joint arthroplasty (TJA) for advanced joint disease is associated with a substantial recovery period. Psychological resilience, defined as the capacity to adapt positively to adversity, may play an important role in shaping patient perceptions and postoperative outcomes. In this systematic review and meta-analysis, we hypothesized that higher preoperative resilience would be associated with better patient-reported outcome measures (PROMs) following TJA. A comprehensive search of the databases PubMed, Embase, and Scopus identified 594 studies, of which nine met the inclusion criteria and examined the relationship between preoperative resilience and postoperative outcomes in TJA patients. These studies, published between 2019 and 2022, included a total of 1,328 patients with a pooled mean age of 67.5 years. Resilience was assessed using the Brief Resilience Scale (BRS) in six studies and the Connor-Davidson Resilience Scale (CD-RISC) in three studies. Assessment of methodological quality demonstrated a low to moderate risk of bias across the included studies. Higher preoperative resilience was significantly associated with better outcomes across multiple measures, including the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Health (PH) and Mental Health (MH) (both p < 0.001), the Knee Injury and Osteoarthritis Outcome Score (KOOS) (p < 0.05), the EuroQol Group 5 Dimension (EQ-5D) (p < 0.001), the EuroQol Group Visual Analogue Scale (EQ-VAS) (p < 0.001), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (p < 0.05). Meta-analysis further confirmed significant associations between resilience and PROMIS-PH, PROMIS-MH, and KOOS scores. Overall, greater preoperative resilience is associated with better postoperative PROMs following TJA. These findings suggest that resilience may be a potentially modifiable factor and highlight the value of a more holistic preoperative approach. However, variability in measurement tools across studies underscores the need for standardized assessment methods. Future research should aim to clarify the mechanisms by which resilience influences recovery and to develop targeted interventions to enhance preoperative resilience and optimize surgical outcomes.