EP8.10 Prediction models incorporating the influence of preoperative mental health for patient outcomes after total knee and hip arthroplasty: a systematic review

Abstract

Abstract Background Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are highly effective treatments for end-stage osteoarthritis. However, a notable proportion of patients experience persistent pain, limited functional improvement, or dissatisfaction following surgery. Increasing evidence suggests that preoperative psychological factors, including anxiety, depression, pain catastrophizing and kinesiophobia significantly influence postoperative outcomes. Several prediction models have been developed to estimate patient-reported outcomes following arthroplasty, yet their reliability, methodological quality, and clinical applicability remain unclear. This systematic review aims to identify, describe and appraise reliability, clinical usability and suitability of preoperative prediction models focused on mental health variables for TKA and THA outcomes. Methods A systematic literature search was performed to identify studies describing the development or update of prediction models for postoperative outcomes after TKA or THA in patients with osteoarthritis. Eligible studies included original research developing a prediction model incorporating preoperative mental health predictors and evaluating outcomes at 6 months or 1 year postoperatively, including capability, pain intensity, or patient satisfaction. Studies were excluded if they were case reports, editorials, protocols, reviews, preliminary reports, or non-English publications. Title and abstract screening identified 1,237 records, followed by full-text screening based on predefined eligibility criteria. Studies meeting inclusion criteria were included for further evaluation. Critical appraisal was performed using the MINORS tool, and levels of evidence were classified according to the Oxford Centre for Evidence-Based Medicine framework. Results Following full-text screening, 32 studies met the eligibility criteria and were included for critical appraisal. These studies describe a variety of prediction models incorporating psychological variables such as depression, anxiety, and pain catastrophizing alongside demographic and clinical predictors. Data extraction includes model characteristics, predictors, modelling approaches, and performance measures including discrimination and calibration. Quality assessment and synthesis of model performance are ongoing. Conclusion Prediction models incorporating preoperative mental health variables may improve identification of patients at risk of poor outcomes after TKA and THA. This systematic review will provide a comprehensive evaluation of current prediction models and identify the most robust model for future external validation. Ultimately, the aim is to improve patient selection and enable more personalized perioperative care in arthroplasty.