Association Between Mental Health Conditions and Revision Rates in Patients Undergoing Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis

Background: The intersection of mental health and outcomes in orthopaedic surgery is an important and complex clinical topic. This systematic review and meta-analysis aimed to examine whether preoperative mental health conditions are associated with the risk of revision or mortality after primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). Methods: PubMed, OVID, Medline, Cochrane, Scopus, Web of Science, and Google Scholar were queried for studies on the association between depressive or psychotic illnesses and revision and mortality after THA or TKA. Risk of bias was assessed according to the methodological index for nonrandomized studies criteria. There were 23 studies that met the inclusion criteria. Random effects models were used to pool hazard ratios (HRs) for meta-analysis. Results: Meta-analysis revealed that patients who have depression had a 32% increased relative risk of revision when undergoing THA or TKA (pooled HR 1.32, 95% confidence interval 1.22 to 1.43). Patients who have psychotic illnesses had a 29% increased relative risk of revision (pooled HR 1.29, 95% confidence interval 1.09 to 1.52). There were two studies that examined associations between depression or psychotic illness and mortality, with mixed findings. Conclusions: Mental health conditions such as depression and psychotic disorders are associated with increased revision risk in patients undergoing THA or TKA. The findings provide surgeons with a basis for individualized preoperative counseling and risk management.