JOA - 2026-09-21 - Journal Article
Association of Recovery and Dissatisfaction with Psychological Distress in Patients Undergoing Total Knee and Hip Arthroplasty in South Australia: A Retrospective Cohort Study of 1,462 Patients.
Aalders MB, SALHN Arthroplasty Research Group, Doornberg JN, Benner JL, Jaarsma RL
Topics
Key Takeaway
Each categorical increase in preoperative anxiety/depression severity raised the odds of dissatisfaction at one year by 51% after TKA (OR 1.51) and 45% after THA (OR 1.45) in an Australian cohort of 1,462 patients.
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Summary
This study asked whether preoperative psychological distress independently predicts poorer functional recovery, QoL, and dissatisfaction at one year after TKA and THA in an Australian population. Generalized estimating equations modeled longitudinal PROMs and multivariable logistic regression assessed dissatisfaction at 12 months using the EQ-5D-5L anxiety/depression subscale as the exposure. Worse psychological distress was independently associated with lower function and QoL across all time points (all P<0.05), with each categorical increase in anxiety/depression increasing dissatisfaction odds by 51% (TKA) and 45% (THA).
Key Limitation
Psychological distress was captured solely by the EQ-5D-5L anxiety/depression item, a non-validated single-dimension proxy that cannot distinguish anxiety from depression, quantify severity thresholds for intervention, or identify catastrophizing—limiting actionability of the findings.
Original Abstract
BACKGROUND
Psychological distress, such as symptoms of anxiety, depression, or catastrophic thinking, is consistently associated with poorer outcomes after total knee and hip arthroplasty (TKA and THA) across different continents globally. However, evidence from Oceania remains limited and methodologically heterogeneous. Given Australia's distinct sociocultural context and comparatively favorable population mental health indicators, it is unclear whether these internationally observed associations are generalizable. This study aimed to determine whether worse psychological symptoms are longitudinally associated with poorer patient-reported function and quality of life (QoL) after TKA and THA in an Australian cohort. A secondary aim was to evaluate whether worse preoperative psychological symptoms are associated with increased risk of dissatisfaction one year postoperatively.
METHODS
A retrospective longitudinal analysis of 1,462 patients undergoing TKA (n = 836) and THA (n = 626) from an Australian hospital was performed. Psychological distress (EQ-5D-5L anxiety/depression), function and QoL patient-reported outcome measures (PROMs) were assessed preoperatively and up to one year. Generalized estimating equations evaluated longitudinal associations between psychological distress and patients' recovery (function, QoL), and multivariable logistic regressions assessed the relation between preoperative psychological distress and dissatisfaction one year postoperatively.
RESULTS
Worse psychological distress was independently associated with significantly lower functional and QoL outcomes over the entire follow-up period in both TKA and THA patients (all P < 0.05). Furthermore, each categorical increase in preoperative anxiety/depression symptoms increased the odds of dissatisfaction at one year (TKA odds ratio 1.51, THA odds ratio 1.45).
CONCLUSION
In Oceania, psychological distress is negatively associated with functional recovery, QoL, and satisfaction after TKA and THA. Considering these findings, building upon prior literature from Oceania and internationally performed studies, it is time to move towards routinely evaluating and addressing psychological factors in THA and TKA populations when patients give the impression of having higher levels of psychological distress.