Abstract
Introduction: There are many factors influencing the outcome after total joint arthroplasty (TJA). In particular, patient-related factors such as age, gender, ASA (American Society of Anesthesiologists), or preoperative anxiety/depression have become increasingly important. The aim of this study was to examine the association of these parameters with 1-year postoperative outcomes after total knee and total hip arthroplasty (TKA, THA). Methods: A retrospective cohort of 5447 TJA patients was evaluated by pre- and postoperative analysis of EQ-5D, EQ-VAS and WOMAC Score. Furthermore, major focus was put on the association between age, gender, ASA, preoperative anxiety/depression and outcome parameters. Results: 53.3% (2903/5447) of all patients were identified with anxiety/depression at time of surgery. In the analysis, patients without anxiety/depression showed statistically significantly (p < 0.05) better EQ-5D, EQ-VAS and WOMAC scores. In addition, patients with ASA 2 or 3 and age over 70 years showed statistically significantly (p < 0.01) worse EQ-5D and WOMAC scores. Gender did not influence the postoperative EQ-5D and WOMAC results, but men had significantly better EQ-VAS scores than women in this study. Conclusion: Preoperative anxiety/depression symptoms show worse clinical outcomes 1 year postoperatively after TJA. Other outcome-influencing factors are higher age and ASA 2 or 3. In the future, such patients should be identified, and as far as applicable, a treatment of anxiety/depression or comorbidities should be implemented preoperatively of the surgical procedure to improve clinical outcomes.
Highlights
Introduction iationsAn estimated 250 million people globally suffer from osteoarthritis, a common chronic musculoskeletal condition [1]
We aimed to determine whether there is an association between age, gender, ASA or anxiety/depression at the time of surgery and outcomes at one year post-surgery following primary elective total hip and total knee arthroplasty
Using data from our hospital information system (ORBIS, Dedalus HealthCare, Bonn, Germany) we performed an analysis to investigate the influence of age, gender, ASA or preoperative anxiety/depression status on post-operative patientreported outcomes (EQ-5D and WOMAC Score) after 1 year in 5447 consecutive patients between 2013 and 2020 after total joint arthroplasty (TJA), 3197 THA and 2250 TKA (Figure 1)
Summary
An estimated 250 million people globally suffer from osteoarthritis, a common chronic musculoskeletal condition [1]. The incidence of osteoarthritis is rising due to overaging, an increasingly overweight society and joint injuries [2]. Symptoms in the affected joint/s such as stiffness, pain and instability, tend to worsen in severity over time [3]. These symptoms can lead to functional limitations, especially considering mobility, as well as decrease of independence in activities of daily living [3,4,5]. In order to improve signs and symptoms of osteoarthritis, the most common orthopedic procedures are elective primary total hip and knee arthroplasty (THA, TKA)
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