Abstract
Background
Prior research has shown that depression negatively impacts outcomes after total hip arthroplasty (THA); however, arthroplasty patients may also have depressive symptoms without an established diagnosis. The purpose of this study was to determine whether the Patient Health Questionnaire-2 (PHQ-2), a two-question depression screener, correlates with joint-specific symptom improvement after primary THA.
Methods
This was a prospective cohort study. Patients completed the PHQ-2 and the Hip Disability and Osteoarthritis Outcome Score - Joint Replacement (HOOS-JR) prior to THA, with follow-up at 6 weeks and 6 months. An a priori power analysis determined a sample size of 31 would detect an effect size of 0.5 with a power of 0.80. We used previously established minimum clinically important difference (MCID) values for HOOS-JR. Continuous variables were analyzed with t-tests or Mann-Whitney tests while categorical variables were analyzed with Chi square or Fisher exact tests.
Results
77 patients were enrolled. 23 (30%) had a PHQ-2 of 3 or higher, indicating a high likelihood of depression. HOOS-JR scores were lower in the high PHQ-2 group at baseline and at six weeks (p<0.05). The two groups were equally likely to reach MCID at six weeks and six months, and there was no significant difference between absolute HOOS-JR scores at six months.
Discussion
Patients with greater depressive symptoms have an equal likelihood of achieving MCID after THA, but worse absolute pain and function at baseline and six weeks after surgery. Administering the PHQ-2 may help surgeons better counsel their patients as to what to expect from surgery. Targeted mental health treatment perioperatively could allow these patients to achieve an even greater improvement in their long-term outcomes.
