Assessment of Psychological Factors in Short-Stay Total Hip Arthroplasty Protocol

Mark A. Oyer*, Adam I. Edelstein, Nathan F. Arnett, Kevin D. Hardt, David W. Manning, Michael D. Stover

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Several variables are known to correlate with the successful completion of short-stay total hip arthroplasty (THA) protocols. The role of psychological factors remains unclear. We investigated the interaction between patient-reported measures of psychological fitness and successful completion of a short-stay THA protocol. Methods: We performed a prospective cohort study of patients undergoing elective anterior total hip arthroplasty enrolled in a short-stay protocol (success defined as LOS ≤1 midnight versus failed, LOS >1 midnight). Psychological fitness was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) domains for self-efficacy, depression, anxiety, emotional support, and the ability to participate in social roles. PROMIS scores, patient demographics, and surgical factors were assessed for a relationship with failure to complete short-stay protocol. Results: Patients that failed to complete the short-stay protocol had higher mean pre-operative PROMIS depression scores (50.8 vs 47.1, P =.025) and anxiety scores (53.6 vs 49.2, P =.008) and higher postoperative PROMIS depression (48.19 vs 43.49, P =.003) and anxiety scores (51.7 vs 47.1, P =.01). Demographic and surgical variables did not correlate with the successful completion of the short-stay protocol. That seventy-six percent of the patients did not adhere to the short-stay protocol was due to the inability to complete a physical therapy standardized safety assessment. Conclusion: Higher levels of preoperative and postoperative anxiety and depression in otherwise psychologically healthy patients, is associated with an increased risk of failure to complete a short-stay protocol following THA. Targeted interventions are needed to facilitate rapid recovery in patients with psychological barriers to early mobilization.

Original languageEnglish (US)
Pages (from-to)1336-1341
Number of pages6
JournalJournal of Arthroplasty
Issue number4
StatePublished - Apr 2021


  • anxiety
  • depression
  • rapid recovery
  • short stay
  • total hip arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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