Anxiety and depression status in geriatric patients undergoing total hip arthroplasty: Correlation with postoperative pain and risk factors

Abstract

BACKGROUND

Anxiety, depression, and postoperative pain are common in patients with hip joint disorders and are associated with compromised functional outcomes and delayed recovery.

AIM

To investigate the prevalence of anxiety and depression among geriatric patients who underwent total hip arthroplasty (THA), explored their association with postoperative pain, and identified contributing risk factors.

METHODS

A total of 111 geriatric patients who underwent THA between January 2021 and January 2024 were included. Standardized psychological assessment tools-including the Zung Self-Rating Anxiety Scale (SAS) and the Zung Self-Rating Depression Scale (SDS)-and the Numeric Rating Scale (NRS) for pain quantification were systematically administered. Pearson correlation analysis was utilized to explore the relationships among SAS, SDS, and NRS scores. Univariate and multivariate binary logistic regression analyses were conducted to identify risk factors for anxiety and depression in these patients.

RESULTS

The cohort exhibited moderate anxiety (SAS: 44.23 ± 9.03), mild depression (SDS: 46.98 ± 9.15), and moderate postoperative pain (NRS: 4.93 ± 2.37). Patients with anxiety or depression reported significantly higher NRS scores than those without these conditions. Significant positive correlations were observed between SAS and SDS scores, as well as between each of these and NRS scores. Univariate analysis revealed that gender, age, disease duration, alcohol use, diabetes history, and NRS scores were significantly associated with anxiety and depression. Multivariate analysis further identified female gender, disease duration ≥ 2 years, alcohol use, and NRS scores ≥ 5 as independent predictors of postoperative psychological distress.

CONCLUSION

Anxiety and depression are closely linked with postoperative pain in geriatric patients post-THA recovery. Early psychological screening and multimodal pain management strategies are recommended-particularly for individuals with a disease duration of ≥ 2 years, a history of alcohol consumption, or an NRS score of ≥ 5, as well as female patients-to effectively mitigate their negative emotional states and improve postoperative recovery.

Keywords: Total hip arthroplasty; Geriatric patients; Anxiety and depression; Postoperative pain; Risk factors

Core Tip: Poor functional and recovery outcomes in patients with hip disorders are often linked to anxiety, depression, and postoperative pain. However, research identifying how anxiety and depression influence pain after total hip arthroplasty (THA) in older patients or their potential determinants is limited. Our findings indicate that a subset of older patients with THA experience anxiety and depression, which correlate with elevated levels of postoperative pain. Clinicians should closely monitor female patients, individuals with long-standing hip disease, alcohol consumers, and patients with high pain scores (assessed using the Numeric Rating Scale), as these groups are at a greater risk of psychological distress.