Preoperative psychotherapy for primary total hip arthroplasty patients: an evaluation of its modifiability on readmissions and implant complications in patients who have depression.

Introduction: Few studies have evaluated nonpharmacologic interventions, including preoperative psychotherapy, in patients who have depression. We studied whether psychotherapy visits prior to total hip arthroplasty (THA) in patients with depression were associated with lower: (1) readmissions; and (2) implant complications in patients who have depression.

Methods: A nationwide database was queried from 2010 to 2021. Patients who had depression were 1:1 propensity score matched based on those who had (n = 16,143) and did not have (n = 16,140) preoperative psychotherapy visits within 3 months of primary THA. These depression patients were 1:5 ratio-matched to a control cohort of patients without comorbid depression (n = 80,627). A 90-day and 2-year follow-up surveillance period was used to evaluate readmissions and implant complications, respectively. Logistic regression models computed the odds ratios (OR) of psychotherapy on readmissions and implant complications. Patients without comorbid depression served as the reference cohort. p-Values less than 0.001 were significant.

Results: Of patients who had depression, a stepwise increase in odds of readmissions occurred for patients who had psychotherapy (6.2 vs. 5.0%, OR 1.25; p < 0.0001) and did not have psychotherapy (6.7 vs. 5.0%, OR 1.36; p < 0.0001) compared to patients who did not have depression. Compared to patients who did not have depression, patients who had depression and did not have psychotherapy experienced greater odds of aseptic loosening (1.7 vs. 0.7%, OR 2.31; p < 0.0001), periprosthetic fractures (0.5 versus 0.2%, OR 2.44; p < 0.0001), dislocations (3.7 vs. 1.6%, OR 2.39; p < 0.0001), periprosthetic joint infections (PJIs) (3.1 vs. 1.7%, OR 1.93; p < 0.0001), and all-cause THA revisions (3.6 vs. 1.5%, OR 2.44; p < 0.0001).

Discussion: Preoperative psychotherapy may provide a modifiable benefit among patients who had depression for 2-year implant complications. This intervention may aid arthroplasty surgeons in optimising patients potentially at higher risk for adverse events.