Psychiatric and Somatic Sequelae After Total Hip Arthroplasty in Patients With Major Depressive Disorder: A Propensity-Matched Analysis.

Abstract

This study evaluated whether major depressive disorder (MDD), a common comorbidity affecting outcomes after total hip arthroplasty (THA), is independently associated with new-onset psychiatric and somatic morbidity. Adults undergoing primary THA (2015-2024) were identified from a multi-institutional database, excluding patients with prior hip pathology or psychiatric diagnoses other than MDD. Propensity score-matched cohorts were compared at 90 days and 1 year using odds ratios (OR) with 95% confidence intervals (CI). After exclusions, 5,864 patients with MDD and 144,640 control subjects were identified, yielding 3,412 matched pairs. P < 0.001 unless otherwise noted. MDD was associated with significantly higher odds of new-onset psychiatric disorders at 90 days and 1 year, including generalized anxiety disorder (OR90d, 22.48: 95% CI, 14.6-34.5; OR1yr, 16.53: 95% CI, 12.0-22.8), adjustment disorder (OR90d, 5.81: 95% CI, 3.9-8.6; OR1yr, 5.40: 95% CI, 3.9-7.4), posttraumatic stress disorder (OR90d, 4.14: 95% CI, 2.8-6.1; OR1yr, 7.33: 95%, CI 5.4-9.9), schizophrenia (OR90d, 2.21: 95% CI, 1.1-4.6: P = 0.03; OR1yr, 2.22: 95% CI, 1.3-3.8: P = 0.002), alcohol use disorder (OR90d, 3.73: 95% CI, 2.6-5.4; OR1yr, 2.61: 95% CI, 1.9-3.6), opioid use disorder (OR90d, 2.31: 95% CI, 1.2-4.3: P = 0.02; OR1yr, 2.69: 95% CI, 1.7-4.2), dementia (OR90d, 12.24: 95% CI, 8.2-18.3; OR1yr, 9.27: 95% CI, 6.6-13.0), and suicide (OR1yr, 6.71: 95% CI, 3.7-12.0). Somatic risks included mortality (OR90d, 2.26: 95% CI, 1.1-4.5: P = 0.02; OR1yr, 1.96: 95% CI, 1.4-2.7), chest pain (OR90d, 1.74: 95% CI, 1.3-2.3; OR1yr, 1.25: 95% CI, 1.1-1.5, P = 0.007), shortness of breath (OR90d, 1.28: 95% CI, 1.0-1.7: P = 0.0498; OR1yr, 1.28: 95% CI, 1.1-1.5, P = 0.002), dizziness (OR1yr, 1.49: 95% CI, 1.2-1.8), and postoperative emergency department visits (OR1yr, 1.27: 95% CI, 1.1-1.5). In patients with isolated MDD, the condition independently increased psychiatric, cognitive, somatic, and mortality risks after THA.