Abstract
Introduction
Preoperative psychological distress has been reported to predict poor outcome and patient dissatisfaction after total hip replacement (THR). We investigated this relationship in a prospective multi-centre study between January 1999 and January 2002.
Methods
We recorded the Oxford Hip Score (OHS) and SF36 score preoperatively and up to five years after surgery and a global satisfaction questionnaire at five year follow up for 1039 patients. We dichotomised the patients into the mentally distressed (Mental Health Scale score - MHS <50) and the not mentally distressed (MHS (50) groups based on their pre-operative MHS of the SF36. 776 (677 not distressed and 99 distressed) out of 1039 patients were followed up at 5 years.
Results
Both pre and post-operative OHS and SF-36 scores were significantly worse in the distressed group (both p<0.001). However, both groups experienced statistically significant improvement in OHS and MHS, which was maximal at 1 year after surgery and was maintained over the follow up. The trend in OHS gain was similar in both groups. There was a substantial improvement in mental distress in patients who reported mental distress prior to surgery. The mentally distressed group also reported better mental health gain compared to the non-distressed group. There was no significant difference in patient satisfaction or willingness to have the surgery again at 5 years following surgery between the two groups.
Conclusion
Despite having worse absolute values both pre and post operatively, patients with mental distress did not have any less functional gain from THR.
