Postoperative Outcomes Following Total Hip and Knee Arthroplasty in Patients with Pain Catastrophizing, Anxiety, or Depression.

Abstract Purpose The relationship between pain catastrophizing, emotional disorders and total joint arthroplasty (TJA) outcomes is an emerging area of study. The purpose of this study was to examine the association of these factors with one-year postoperative pain and functional outcomes. Methods A prospective cohort study of preoperative TJA patients using the Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scale (HADS-A/HADS-D) was conducted. Postoperative outcomes included visual analogue pain scale (VAS), Oxford, Harris Hip (HHS) and Knee Society (KSS) scores. Median regression was used to assess the pattern of relationship between preoperative clinically relevant pain catastrophizing (CRC), abnormal HADS and one-year postoperative outcomes. Results We recruited 463 TJA patients, all of which completed one-year follow-up. At one-year, CRC-rumination (adjusted median difference 1; 95%CI 0.31-1.69,p=0.005) and abnormal HADS-A (adjusted median difference 1; 95%CI 0.36-1.64,p=0.002) were predictors of VAS pain, CRC-magnification, a predictor of HHS/KSS (adjusted median difference 1.3; 95%CI 5.23-0.11,p=0.041), and abnormal HADS-A a predictor of Oxford (adjusted median difference 3.68; 95%CI 1.38-5.99,p=0.002). CRC patients demonstrated inferior VAS pain (p=0.001), Oxford (p Conclusion TJA patients who are anxious, depressed or pain catastrophize have inferior preoperative and postoperative pain and function. However, as compared to their preoperative status, clinically significant improvement can be expected following hip/knee arthroplasty.