Mental health disorder
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%.