Abstract
Objective: The Charnley grading system (A, B, C) has previously been shown to be a valid predictor concerning outcome after joint replacement surgery. In this study we hypothesized that anxiety/depression, one of five dimensions in the health related quality of life measurement tool EQ-5D, could predict the outcome after total hip replacement surgery.
Methods: Data from the Swedish Hip Arthroplasty Register including 6 158 patients with primary osteoarthritis were analysed. To examine the association of anxiety with respect to the outcome of pain (VAS) and satisfaction (VAS) a general linear regression model was used.
A subgroup of 481 patients in the Western Region of Sweden with complete data on individual CPP (cost per patient) was selected for the health economic analysis.
Results: The preoperative EQ-5D anxiety/depression dimension was a strong predictor for pain relief, patient satisfaction, and cost-effectiveness with surgery. Patients with comorbidity (Charnley category C) had a significant worse outcome with regards to pain relief, satisfaction and EQ-5D index scores than patients in Charnley category A and B (p< 0.001). Females generally had worse outcome scores than males in all three outcome measurements (p< 0.001).
Conclusion: Orthopaedic surgeons involved with the care of patients eligible for THR surgery should be alert to the fact that mental health may influence pain-experience and HRQoL outcome. Appropriate assessment of mental health may enable us to modify the approach in which we manage these patients, in order to optimize the outcome following joint replacement surgery.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Email: office@efort.org
