Resilience and Depression Influence Clinical Outcomes Following Primary Total Joint Arthroplasty

J Arthroplasty. 2021 May;36(5):1520-1526. doi: 10.1016/j.arth.2020.11.032. Epub 2020 Nov 25.


Background: Resilience and depression may impact clinical outcomes following primary total joint arthroplasty (TJA). This study aimed to quantify baseline resilience and depression prevalence in patients undergoing primary TJA and evaluate their influence on patient-reported clinical outcomes.

Methods: We prospectively enrolled 98 patients undergoing primary TJA. Exclusion criteria included patients under 18 years of age, undergoing surgery for fracture, or who underwent additional surgery during the study period. Patients completed the Brief Resilience Scale to measure resilience, Patient Health Questionnaire-9 to measure depression, and Patient-Reported Outcomes Measurement Information System-10 to measure global physical and mental health preoperatively and 1 year postoperatively.

Results: Preoperatively, 22% and 15% of patients demonstrated major and mild depression, respectively. High resilience was identified in 34% of patients, normal resilience in 55%, and low resilience in 11%. Preoperative depression correlated with lower resilience, global physical health, and global mental health scores preoperatively as well as at 1 year after surgery (P < .001). Higher levels of preoperative resilience correlated with higher global physical and mental health scores preoperatively and at 1 year postoperatively (P < .001).

Conclusion: Depression symptoms are common among patients undergoing primary TJA and are associated with worse patient-reported outcomes. Patients with higher levels of resilience have higher global physical and mental health scores before and after TJA. Psychological traits and depression impact clinical outcomes following TJA.

Keywords: depression; mental health; psychosocial; resilience; total joint arthroplasty.

MeSH terms

  • Adolescent
  • Arthroplasty, Replacement, Hip*
  • Arthroplasty, Replacement, Knee*
  • Depression / epidemiology
  • Depression / etiology
  • Humans
  • Mental Health
  • Patient Reported Outcome Measures
  • Treatment Outcome