How Mental Health Can Impact Joint Replacement Outcomes

Good mental health is integral to a happy and successful life after joint replacement

Patients with advanced arthritis have benefited greatly from joint replacement procedures. These procedures have been proven to be highly effective in reducing pain and improving mobility and overall quality of life. Despite being called “the operation of the century,” not all end up feeling satisfied with the outcome, and the quality of life actually goes down1.

Psychiatric illnesses are on the rise globally. In addition to negatively impacting the quality of life and social functioning, psychiatric illnesses have been linked to a wide range of secondary medical issues and the onset and worsening of pre-existing conditions. The correlation between mental health issues like depression and anxiety and other health problems like heart disease, diabetes, asthma, smoking, and obesity has been established by numerous studies. In addition, depression and anxiety are more prevalent than average in people with musculoskeletal disorders such as osteoarthritis and degenerative spine disease.

While the physical outcomes of joint replacement surgery are well documented, the impact of mental health on joint replacement outcomes is often overlooked. This article will explore the connection between mental health and joint replacement and why mental health should be considered an essential component of post-joint rehabilitation.

Mental health is a broad term for a person’s emotional, psychological, and social well-being. It can greatly influence how people experience pain and cope with it.

Pain relief and functional improvement after total joint arthroplasty are just two examples of the long-term outcomes that are affected by the presence of depression or anxiety, according to several studies2. Others have hypothesized a link between musculoskeletal pain and disability and mental illness, arguing that orthopedic surgery could benefit both3. There is evidence from other fields that factors like pain catastrophizing, pain-related fears of movement, and depression increase the likelihood that an individual will experience chronic pain and disability4. The development of depressive symptoms has also been linked to the progression from acute to chronic pain. Similarly, this can lead to increased levels of pain post-surgery, making it more difficult for them to recover from the procedure.

Another factor that affects mental health is a person’s level of anxiety about the procedure. Contradictory data comparing the level of anxiety, higher levels of pain, and satisfaction with their joint replacement outcome is available. There is no debate that anxiety and stress can cause physical symptoms such as muscle tension, headaches, and difficulty sleeping, which can exacerbate pain and impact recovery. However, the contribution of anxiety levels to post-operative recovery is still debatable.

Similarly, it was observed that anxious and depressed patients often required more time in the hospital and were more likely to be transferred to a rehabilitation center than to return home. The cost of their hospital stay was much higher than average. Patients with major depression, anxiety, or both had significantly lower odds for routine discharge and higher odds for increased length and cost of hospitalization (median and 75th percentile, respectively), according to research published in 20135.

The problems just do not stop here. Moreover, people who suffer from poor mental health also have a higher likelihood of developing post-operative complications, such as infection and implant failure. This can lead to additional surgeries and further delay recovery, causing a vicious cycle of decreased mental health, increased pain, and decreased satisfaction with joint replacement.

As mentioned above, it has been seen that patients who have been depressed owing to the reduced range of motion due to arthritis and constant pain had significant mental well-being post-procedure. In a study published in 2019, it was found that the mean WOMAC score was 40.6 (SD 16.5) (n = 674) before surgery and 82.9 (SD 15.5) (n = 577) 1 year postoperatively, a mean increase of 41.4 (SD 18.8) (n = 574) (p < 0.001). The corresponding values for the SF-36 mental health score were 72.2 (SD 18.4) (n = 676) and 81.1 (SD 15.7) (n = 577), a mean increase of 7.9 (SD 16.6) (n = 576) (p = 0.01), affirming the already stated statement.

This clearly demonstrates that it is essential to consider and assess a patient’s mental health when a plan is made for joint replacement. A comprehensive mental health assessment should be carried out before their surgery. This will help identify any mental health conditions that need to be addressed and treated. A good idea can also be made if the patient suffers from a low mood due to the pain and lack of mobility caused due to arthritis.

Additionally, given the impact of mental health on joint replacement outcomes, mental health must be made a compulsory part of post-joint rehabilitation. Patients should be assessed for their mental health and provided with psychological support and resources to help them manage their mental health and promote their overall well-being. This may include individual or group therapy, mindfulness-based therapies, and access to support groups and other resources.

It is no debate that joint replacement surgeries have the potential to significantly improve physical function and quality of life for individuals with joint diseases. However, mental health must be considered an integral component of joint replacement to ensure patients achieve the best possible outcomes. By including mental health in post-joint rehabilitation, patients can receive the support they need to manage their physical and emotional well-being and achieve a more successful outcome after joint replacement surgery


1. Learmonth, Ian D., Claire Young, and Cecil Rorabeck. “The operation of the century: total hip replacement.” The Lancet 370.9597 (2007): 1508-1519.
2. Rolfson, O., et al. “Variables determining outcome in total hip replacement surgery.” The Journal of Bone and Joint Surgery. British volume 91.2 (2009): 157-161.
3. Jaiswal, Parag, et al. “Impact of preoperative mental health status on functional outcome 1 year after total hip arthroplasty.” Canadian Journal of Surgery 62.5 (2019): 300.
4. Burns, Lindsay C., et al. “Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review.” Journal of pain research (2015): 21-32.
5. Stundner, Ottokar, et al. “Demographics and perioperative outcome in patients with depression and anxiety undergoing total joint arthroplasty: a population-based study.” Psychosomatics 54.2 (2013): 149-157.


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