Associations of Preoperative Anxiety/Depression (EQ-5D-5L) With Pre- and Postoperative Health-Related Quality of Life for Hip and Knee Replacement

OBJECTIVES:

Previous literature revealed ambiguous results about preoperative anxiety and depression as predictors for health-related quality of life (HRQoL) before and after total hip replacements (THR) and total knee replacements (TKR). This study aimed to evaluate whether problems reported preoperatively in the dimension of anxiety/depression from the EQ-5D-5L questionnaire were related to overall disease-specific and generic health perception, both before and after THR and TKR.

METHODS:

597 patients, with osteoarthritis and primary THR or TKR from a single hospital, were included. HRQoL was measured preoperatively and 1 year after surgery with the EQ-5D-5L, the EQ-Visual-Analog-Scale (EQ-VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Multivariate linear regression was used to account for patient characteristics such as age, gender, ASA Score, Body Mass Index, pain medication, residence, hemoglobin, physical activity, marital status, postoperative complications, spinal anesthesia, and knee implant types.

RESULTS:

For THR and TKR, preoperative anxiety was related to both preoperative WOMAC Scores (p<0.001) and EQ-VAS (p<0.01), but for neither of these two indicators postoperatively. The postoperative outcomes were primarily associated with the preoperative health states for THR. Although, improvements did not reach literature-based, minimum clinical important differences (MCID). The postoperative EQ-VAS for TKR was associated with complications, occurring postoperatively, but not related to surgery (p<0.001). For patients with these complications, EQ-VAS was 14.8 points lower, thereby almost reaching the MCID.

CONCLUSIONS:

For THR and TKR, preoperative anxiety/depression (EQ-5D-5L) was associated with preoperative WOMAC Scores and preoperative EQ-VAS, but not with postoperative outcomes. Patients with different levels of preoperative WOMAC Scores and EQ-VAS had similar outcomes 1 year after surgery for THR. A spin-off, but important confounder result revealed an association of postoperative EQ-VAS for TKR with postoperative complications. Hence, complications during the follow-up period should be investigated to avoid biases in scientific studies and in quality assessments in practice.