Moderate strength evidence supports that mental health disorders, such as depression, anxiety, and psychosis, are associated with decreased function, pain relief, and quality of life outcomes in patients with symptomatic osteoarthritis of the hip who undergo total hip arthroplasty (THA).


Six moderate quality studies (Davis, 2006; Duivenvoorden, 2013; Gandhi, 2010; Jamsen, 2013; Judge, 2013; Rolfson, 2009) support this recommendation.  Mental health disorders were assessed using a variety of validated tools including the SF36 Mental Component Score (Judge, 2013; Gandhi, 2010), the depression/anxiety question on the EQ-5D (Rolfson, 2009) and the HADS (Duivenvoorden, 2013).  Functional outcomes were assessed utilizing the Oxford Hip Score, WOMAC or HOOS.  The presence of depression preoperatively predicted a lower functional outcome and/or less improvement between pre-operative and post-operative function.  In one long-term study (Jamsen, 2013), patients with depression were found to exceed 10% revision rate at ten years; pre-operative psychosis increased the risk of implant failure with Kaplan Meier Survivorship analysis by 40%.

  1. Davis,A.M.; Agnidis,Z.; Badley,E.; Kiss,A.; Waddell,J.P.; Gross,A.E. Predictors of functional outcome two years following revision hip arthroplasty. J Bone Joint Surg Am; 2006/4: 4
  2. Duivenvoorden,T.; Vissers,M.M.; Verhaar,J.A.; Busschbach,J.J.; Gosens,T.; Bloem,R.M.; Bierma-Zeinstra,S.M.; Reijman,M. Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study. Osteoarthritis Cartilage; 2013/12: 12
  3. Gandhi,R.; Dhotar,H.; Davey,J.R.; Mahomed,N.N. Predicting the longer-term outcomes of total hip replacement. J Rheumatol.; 2010/12: 12
  4. Jamsen,E.; Peltola,M.; Eskelinen,A.; Lehto,M.U. Comorbid diseases as predictors of survival of primary total hip and knee replacements: a nationwide register-based study of 96 754 operations on patients with primary osteoarthritis. Ann Rheum.Dis; 2013/12: 12
  5. Judge,A.; Arden,N.K.; Batra,R.N.; Thomas,G.; Beard,D.; Javaid,M.K.; Cooper,C.; Murray,D. The association of patient characteristics and surgical variables on symptoms of pain and function over 5 years following primary hip-replacement surgery: a prospective cohort study. BMJ Open; 2013: 3
  6. Rolfson,O.; Dahlberg,L.E.; Nilsson,J.A.; Malchau,H.; Garellick,G. Variables determining outcome in total hip replacement surgery. J Bone Joint Surg Br; 2009/2: 2