Published online Jun 19, 2026. doi: 10.5498/wjp.v16.i6.116745
Revised: December 27, 2025
Accepted: February 25, 2026
Published online: June 19, 2026
Processing time: 188 Days and 0.1 Hours
Although total joint arthroplasty effectively treats end-stage joint diseases, 10%-30% of patients experience poor outcomes. Preoperative anxiety and depression are common, but their long-term prognostic impact remains unclear. This study aimed to investigate the association between preoperative anxiety/depression and two-year outcomes after total hip or knee arthroplasty.
To evaluate the impact of preoperative anxiety and depression on joint function, pain, quality of life, and complication occurrence at 2 years postoperatively in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA).
A case-control study design was employed, retrospectively enrolling 320 patients who underwent primary unilateral THA or TKA between January 2021 and December 2022, with 246 patients completing a 2-year follow-up (follow-up rate 76.9%). The Hospital Anxiety and Depression Scale (HADS) was used to assess preoperative psychological status, dividing patients into an exposed group (HADS-Anxiety Subscale ≥ 8 points and/or HADS-Depression Subscale ≥ 8 points) and a non-exposed group (HADS-Anxiety Subscale < 8 points and HADS-Depression Subscale < 8 points). The 1:1 propensity score matching was applied to balance baseline characteristics, with 92 cases included in each group after matching. Harris score and Hospital for Special Surgery score were used to evaluate joint function, the Visual Analogue Scale to assess pain, the Short Form-36 Health Survey to evaluate quality of life, and postoperative complications were recorded. Repeated measures analysis of variance was used to compare outcome indicators at different postoperative time points between groups, and multivariate logistic regression was performed to analyze the independent effect of preoperative anxiety and depression.
After matching, baseline characteristics were balanced between the two groups (P > 0.05). At 1 and 2 years postoperatively, joint function scores in the exposed group were lower than in the non-exposed group: Harris scores at 2 years postoperatively for THA patients were 82.6 ± 8.7 vs 89.3 ± 6.9 (P < 0.001), and Hospital for Special Surgery scores for TKA patients were 80.8 ± 8.3 vs 87.1 ± 7.5 (P = 0.001). At 1 and 2 years postoperatively, Visual Analogue Scale scores at rest and during activity in the exposed group were higher than in the non-exposed group (P < 0.001). At 2 years postoperatively, Short Form-36 Health Survey scores and improvement magnitudes in all dimensions were lower in the exposed group than in the non-exposed group (P < 0.05). The total complication rate at 2 years postoperatively in the exposed group was 29.3% (27/92), higher than 14.1% (13/92) in the non-exposed group (P = 0.010). Multivariate logistic regression analysis showed that after adjusting for confounding factors, preoperative anxiety and depression were independent risk factors for poor joint function at 2 years postoperatively (odds ratio = 3.84, 95% confidence interval: 1.92-7.68, P < 0.001) and complication occurrence (odds ratio = 2.67, 95% confidence interval: 1.28-5.57, P = 0.009).
Preoperative anxiety and depression are independent risk factors for poor joint function and complication occurrence at 2 years postoperatively in THA and TKA patients, producing persistent negative impacts on pain relief and quality of life improvement. Clinical practice should emphasize perioperative psychological assessment and intervention to improve overall patient prognosis.
Core Tip: Anxiety and depression, as measured by the Hospital Anxiety and Depression Scale, before surgery have a long-term adverse effect on total hip arthroplasty and total knee arthroplasty outcomes. This study, which incorporates propensity score matching and two-year follow-up, shows anxiety and depression is an independent predictor of joint function, pain relief, quality of life, and complications. This research highlights the importance of psychological screening and interventions during the perioperative period in arthroplasty.