Prevalence of Depressive Symptoms in Patients Undergoing Aseptic Revision Total Hip Arthroplasty Differs Based on Mode of Failure

Abstract

Background

Complications following total hip arthroplasty (THA) may necessitate a revision and patients who go on to a revision THA may experience depressive symptoms. The objective of this study was to investigate the prevalence of depressive symptoms before and after revision THA for six different failure modes.

Methods

Patients who underwent a THA revision with minimum 1-year follow-up at a single institution from 2008 to 2022 were retrospectively reviewed. Patients were grouped by failure modes: aseptic loosening, impingement, infection, instability, metallosis, polyethylene wear, and femoral stem pain. Preoperative and postoperative Veterans RAND 12-Item Health Scores and Harris Hip Score were compared.

Results

Twenty-four percent of patients in the retrospective cohort review had a previous existing mental health diagnosis, with depression being the most common (18% of all patients). The prevalence of depressive symptoms differed significantly by failure mode both preoperatively (P = .002) and postoperatively (P = .019). Veterans RAND 12 mental component score was significant between mode of failure groups both preoperatively (P < .001) and postoperatively (P = .005). Function significantly improved in all groups from preoperatively to postoperatively. Patients with depressive symptoms had significantly lower physical component score with instability, aseptic loosening, stem pain, and metallosis preoperatively (P < .001) and with instability, aseptic loosening, stem pain, and polyethylene wear postoperatively (P = .002).

Conclusions

Nearly 25% of patients with failed THA had a pre-existing mental health diagnosis and depressive symptoms were the most common. Unfortunately, depressive symptoms only improve modestly with revision surgery and can adversely affect a patient’s functional outcome.