Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut.
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
J Bone Joint Surg Am. 2018 Oct 17;100(20):1735-1741. doi: 10.2106/JBJS.17.01677.
Depression and poor mental health are known to be negative predictors of patient-reported outcomes after total joint arthroplasty. Although previous studies have examined these risk factors in isolation to each other, they are, in reality, closely related, and yet each represents a different aspect of one's psychological well-being. The objective of this study was to investigate the association between depression and patient-reported outcomes, taking into account patients' baseline mental health.
Our prospective, institutional joint registry was queried for patients who had undergone primary elective total joint arthroplasty and had a minimum follow-up of 1 year. Baseline mental health was measured by the Short Form-12 Mental Component Summary (SF-12 MCS). Four cohorts were analyzed on the basis of the presence or absence of depression and patients' SF-12 MCS scores at the time of the surgical procedure, which were categorized as either poor or good on the basis of previously defined cutoffs. The primary outcomes were the net changes in SF-12 MCS, SF-12 Physical Component Summary (PCS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at 4 and 12 months postoperatively. Univariate and mixed-effects model analyses were performed to control for potential confounding factors.
Patients with depression but good baseline mental health achieved gains in patient-reported outcomes that were comparable with those of normal controls (p > 0.05). Patients with poor baseline mental health achieved significant gains in all patient-reported outcomes, but the changes were largest for those without depression (p < 0.05). Only patients with depression and poor baseline mental health did not cross the threshold for good mental health at the time of the latest follow-up despite achieving similar gains in physical function compared with their counterparts who did not have depression.
The effect of depression on patient-reported outcomes is more complex but less pessimistic than previously thought. Patients with depression undergoing total joint arthroplasty may have significant improvements in their patient-reported outcomes, but the net gains are modulated by their mental health at the time of the surgical procedure. Preoperative screening of patients with depression using the SF-12 MCS may help to identify those who are at risk for attaining suboptimal patient-reported outcomes and may benefit from counseling or psychiatric referral for optimization before undergoing a surgical procedure.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
抑郁和心理健康不良是全关节置换术后患者报告结局的已知负面预测因素。尽管先前的研究已经分别检查了这些危险因素，但实际上，它们是密切相关的，并且每个因素都代表了一个人心理幸福感的不同方面。本研究的目的是调查抑郁与患者报告结局之间的关联，同时考虑到患者的基线心理健康状况。
我们对接受初次择期全关节置换术且随访至少 1 年的患者进行前瞻性机构关节登记处查询。基线心理健康状况通过短格式 12 项心理健康成分量表（SF-12 MCS）进行测量。根据是否存在抑郁以及患者手术时的 SF-12 MCS 评分，将四个队列进行分析，根据先前定义的截定点将评分分为差或好。主要结局是术后 4 个月和 12 个月时 SF-12 MCS、SF-12 物理成分量表（PCS）和西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）评分的净变化。进行单变量和混合效应模型分析以控制潜在的混杂因素。
尽管抑郁但基线心理健康良好的患者在患者报告结局方面取得的改善与正常对照组相当（p>0.05）。基线心理健康状况较差的患者在所有患者报告结局方面均取得显著改善，但无抑郁患者的改善幅度最大（p<0.05）。尽管在物理功能方面取得了相似的改善，但仅患有抑郁和基线心理健康状况较差的患者在最新随访时仍未达到良好心理健康的阈值，尽管与没有抑郁的患者相比，他们的心理健康状况较差。
抑郁对患者报告结局的影响比之前认为的更为复杂但不那么悲观。接受全关节置换术的抑郁患者可能会显著改善其患者报告结局，但手术时的心理健康状况会调节净收益。使用 SF-12 MCS 对患有抑郁的患者进行术前筛查可能有助于识别那些获得不理想患者报告结局风险较高的患者，并可能有助于在接受手术前通过咨询或精神病转诊进行优化。
预后 III 级。请参阅作者说明以获取完整的证据水平描述。
