To mark Mental Health Awareness Week, we are looking at the impact of mental health problems on surgical outcomes, specifically in relation to total knee replacements.
Joint replacement surgery is a highly effective and successful procedure that offers people the chance to regain their mobility and their quality of life. It is performed routinely for patients who are suffering from severe arthritis or trauma injuries and knee replacements are one of the most common of all orthopaedic surgical procedures.
The role of mental health in joint replacement outcomes
However, while surgical skill, improvements in prosthetic implants and advances in care all play a role in ensuring a positive outcome from total knee replacements, there are other contributory factors, including the patient’s own mental health and wellbeing. Some patients continue to experience pain and discomfort after surgery and a research team from the Department of Orthopaedic Surgery at three Massachusetts hospitals in the US was keen to explore how much of a role the patient’s mental health plays in surgical outcomes
Their study, published in The Journal of Arthroplasty in August 2020, considered whether a patient’s mental health before surgery might affect their experience of pain following the procedure, as well as their ability to regain full function.
Researchers looked at 1392 patients who underwent knee replacement surgery at three community hospitals and two academic medical centres between October 2015 and December 2018. Their mental health and physical function scores were rated using three measures – the Patient-Reported Outcomes Measurement Information System (PROMS) Global Health, PROMS Physical Function 10a and Knee Injury and Osteoarthritis Outcome Score Physical Function (KOOS-PS).
Patients were assessed before their operation and up to a year after their operation. They were categorised according to their mental health prior to surgery – ranging from ‘poor’ to ‘excellent’.
Poor mental health equates to poorer outcomes
Researchers found that patients who had better mental health before surgery demonstrated higher physical function scores both before and after their operation. All patients were found to have improve physical function immediately after surgery but there were significant differences a year after surgery. Patients with the worst mental health scores experienced a sharp decline in physical function approximately one year after surgery and did not appear to recover.
Seek help prior to surgery
This research has important implications for anyone who is scheduled to undergo a knee replacement who is suffering from poor mental health. It does not mean you should avoid having joint replacement surgery, but it is important to discuss the issue with your orthopaedic surgeon who may be able to advise on treatment for your mental health problems to help prevent post-surgical deterioration. The study authors also recommend tighter follow-up guidelines and more frequent physiotherapy sessions for those people most at risk of deterioration.
Impact of lockdown
Joseph Queally recognises that many people’s mental health has suffered during the recent lockdowns and people with degenerative conditions like osteoarthritis may have experienced a worsening of symptoms.
Knee replacement surgery is a life-changing procedure that can help you to regain your function and quality of life. It is an effective and lasting way to relieve pain and restore mobility. However, if you are experiencing mental health problems, it is advisable to seek professional help prior to surgery to help you manage this so you can experience the best possible surgical outcomes afterwards.
Contact us to discuss knee replacement surgery and how we might be able to help you to access the right professional support for mental health problems before your procedure.