Evaluating the effects of anxiety disorder on physical and psychosocial measures for indigent patients with severe lower extremity osteoarthritis

Background: The purpose of this study was to evaluate the effects of anxiety disorder on preoperative physical and psychosocial measures for patients undergoing lower extremity total joint arthroplasty. It was hypothesized that patients with anxiety disorder would express higher levels of pain, worse function, and worse quality of life indices. Methods: Four hundred and four indigent patients undergoing total knee or hip arthroplasty were assessed for anxiety disorder. Patients with anxiety disorder (n=48) were compared with patients without anxiety disorder (n=356) at the univariate level for the Western Ontario and McMaster Universities (WOMAC) score, Knee Society Score, Harris Hip Score, and the Short Form- 36 (SF-36). Results: Twenty-eight (10.6%) of 265 patients who had total knee arthroplasty and 20 (14.4%) of 139 patients who had total hip arthroplasty met the criteria for anxiety disorder on the patient health questionnaire. Overall, 48 (11.9%) of 404 patients undergoing total knee or total hip arthroplasty met these criteria for anxiety disorder on the patient health questionnaire. Patients with anxiety disorder were significantly more likely to report greater levels of pain and stiffness along with lower levels of function and quality of life indices before surgery. Conclusions: The results of this study support the hypothesis that patients diagnosed with anxiety disorder before undergoing total knee arthroplasty or total hip arthroplasty would report poorer scores on physical and psychosocial measures before surgery. Recognizing how anxiety disorder relates to pain catastrophizing and fear avoidance factors may explain the mechanism for which psychological distress translates into poor function and greater pain.