Preoperative Psychopharmacological Treatment Is Not a Risk Factor for Poorer Patient-Reported Improvements 12 months After Hip or Knee Arthroplasty: A Multicenter Registry-Based Cohort Study of 7,247 Procedures

Simon Kornvig; Henrik Kehlet; Christoffer C Jørgensen; Anders Fink-Jensen; Poul Videbech; Thomas Jakobsen; Kirill Gromov; Claus Varnum

doi:10.1016/j.arth.2024.10.026

Preoperative Psychopharmacological Treatment Is Not a Risk Factor for Poorer Patient-Reported Improvements 12 months After Hip or Knee Arthroplasty: A Multicenter Registry-Based Cohort Study of 7,247 Procedures

J Arthroplasty. 2024 Oct 16:S0883-5403(24)01039-8. doi: 10.1016/j.arth.2024.10.026. Online ahead of print.

Authors

Simon Kornvig¹, Henrik Kehlet², Christoffer C Jørgensen³, Anders Fink-Jensen⁴, Poul Videbech⁵, Thomas Jakobsen⁶, Kirill Gromov⁷, Claus Varnum⁸

Affiliations

¹ Department of Orthopaedic Surgery, Lillebaelt Hospital, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
² Section for Surgical Pathophysiology, Copenhagen University Hospital, Copenhagen, Denmark; Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.
³ Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark; Department of Anaesthesia, Hospital of Northern Zealand, Hillerød, Denmark.
⁴ Mental Health Center, Frederiksberg and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁵ Mental Health Center, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁶ Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark; Department of Orthopaedic Surgery, Aalborg University Hospital, Farsø, Denmark.
⁷ Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark; Department of Orthopaedic Surgery, Hvidovre Hospital, Hvidovre, Denmark.
⁸ Department of Orthopaedic Surgery, Lillebaelt Hospital, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.

PMID: 39419411
DOI: 10.1016/j.arth.2024.10.026

Abstract

Background: Preoperative psychopharmacological treatment (PPT) has been associated with increased hospital length of stay and readmission rate after hip and knee arthroplasty. However, little is known regarding the association between PPT and improvements in patient-reported outcomes postoperatively in a multicenter fast-track setting. Thus, the primary objective was to investigate whether PPT is a risk factor for poorer patient-reported improvements 12 months after surgery. Secondary objectives included assessment of additional time points and subgroups of PPT.

Methods: This multicenter registry-based cohort study included 4,021 primary hip and 3,226 primary knee arthroplasties performed from 2016 to 2020 at three fast-track departments in Denmark due to primary osteoarthritis. The Oxford Hip Score/Oxford Knee Score (OHS/OKS), EuroQol-5 Dimensions-3 Levels/EuroQol-5 Dimensions-5 Levels, and EuroQol visual analog scale were collected at baseline and 3, 6, 12, and 24 months after surgery. Exposure status was assigned using the Danish National Prescription Registry. Marginal mean differences (MD) with 95% confidence intervals (CIs) were estimated using multilevel Tobit regression and adjusted for age, sex, and the Charlson Comorbidity Index obtained from the Danish National Patient Register.

Results: No associations were found between PPT and improvements in OHS (MD -0.5, CI -1.4 to 0.4) or OKS (MD -0.3, CI -1.2 to 0.5) after 12 months. However, PPT was associated with lower baseline OHS (MD -1.4, CI -2.2 to -0.6) and OKS (MD -2.1, CI -2.9 to -1.3), and 12 months follow-up OHS (MD -1.9, CI -2.8 to -1.1) and OKS (MD -2.4, CI -3.2 to -1.6). Similar findings were observed at other time points, using EuroQol-5 Dimensions-3 Levels/EuroQol-5 Dimensions-5 Levels or EuroQol visual analog scale, and when evaluating PPT subgroups.

Conclusions: In hip and knee arthroplasty, PPT was not a risk factor for poorer patient-reported improvements 12 months after surgery. However, PPT was associated with marginally poorer baseline and follow-up scores. Thus, arthroplasties remain effective treatments despite PPT from a patient-centered perspective.

Keywords: knee arthroplasty; multicenter; patient-reported outcome; psychopharmacological treatment; total hip arthroplasty.