Abstract
Preexisting depression negatively impacts outcomes following total hip arthroplasty
(THA). Patient-Reported Outcomes Measurement Information System (PROMIS) surveys are
validated measures which quantify depression, pain, and physical function. We hypothesized
that higher levels of preoperative PROMIS depression scores were associated with inferior
outcomes following THA. A total of 247 patients underwent primary THA at the same
institution by three arthroplasty surgeons between June 2018 and August 2020. PROMIS
scores were collected preoperatively and at 6 weeks, 3 months, and 1 year postoperatively.
Patients with preoperative PROMIS depression scores of 55 or more were considered
depressed. The primary outcome measures were changes in PROMIS scores over time. Secondary
outcomes were total morphine milligram equivalent (TME) and mean morphine equivalents
per day (MME) received during admission, 90-day emergency room visits and hospital
readmissions, and revisions within 2 years. Seventy-eight patients had preoperative
PROMIS depression scores of 55 (PD) or more and 169 were not depressed (ND). PD patients
were younger (PD: 62.0 [14.3] vs. ND: 66 [11.7], p = 0.028) at time of surgery and had higher TME (PD: 211.5 [320.9] vs. ND: 161.5 [375.9],
p = 0.022) and MME (PD: 78.0 [71.6] vs. ND: 59.1 [67.3], p = 0.005) usage during hospitalization compared to ND patients. PD patients had higher
preoperative PROMIS scores for pain (p < 0.001) and lower scores for function (p < 0.004). PD patients had improved PROMIS depression scores at all follow-up intervals
(p < 0.01). All other changes in PROMIS pain and function scores were not different
between groups. There were no significant differences in readmission rates or patients
requiring revisions. Preoperative PROMIS depression scores of 55 or more do not negatively
impact postoperative function, depression, or pain following THA, and are associated
with greater improvement in depression. There also is not a higher rate of revisions
or readmissions.
Keywords
hip - patient-reported outcomes - depression - mental illness
