Psychological Factors Associated with Function and Health-Related Quality of Life Outcomes following Total Hip or Knee Arthroplasty: An Umbrella Review of Systematic Reviews

BACKGROUND: There is growing interest in identifying psychological factors associated with outcomes following total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, the available evidence is heterogeneous, and uncertainty remains regarding which psychological factors are most consistently associated with postoperative outcomes following arthroplasty. The aim of this study was to provide an overview of available evidence of association between psychological factors and function or health-related quality of life (HRQoL) after arthroplasty. METHODS: An umbrella review was conducted, and 3 electronic databases were searched, and systematic reviews were included. We reported the risk of bias assessments of primary studies as reported in systematic reviews. Only high quality studies were included in qualitative synthesize. RESULTS: A total of 25 systematic reviews, including data from 40,024 patients, were included. Two psychological vulnerability factors, including depression, and anxiety negatively affect postoperative function/HRQoL after THA or TKA. Our findings also indicated that distress, kinesiophobia, pain catastrophizing, and pessimism negatively impact postoperative function/HRQoL outcomes following TKA, though no reviews have addressed these factors for THA. Conversely, the psychological protective factors of patient expectations and mental well-being were found to positively influence function/HRQoL outcomes following both TKA. CONCLUSION: These findings may help clinicians target specific elements to enhance the management of patients and could potentially improve outcomes by addressing these factors through tailored interventions. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.