The Effects of Mental Health on Knee Replacement Outcomes

The Problem An important part of remaining healthy when we get older, is remaining mobile or walking. Arthritis is the ‘wear and tear’ of our joints that happens as we age. Unfortunately, as we get older, arthritis can cause pain and stop our ability to walk and enjoy life. People with arthritis are then at a high risk of getting other long-term problems. An example of this is getting a mental health problem, like depression, because people live with pain for a long time. A knee replacement is a common surgery to help people with bad arthritis in their knees. However, 1 in 5 people have a bad results after their operation. The bad results might be for a variety of reasons. These include being unhappy with their new knee, still having pain after surgery, or they might suffer from a complication (where surgery goes wrong). We know people with mental health problems are more likely to have a bad result when compared to people without mental health problems. We don’t know which people with mental health problems are at the highest risk. This is because we haven’t studied their mental health closely enough. Before surgery, healthcare workers help treat physical problems, like high blood pressure. However, we don’t currently check or treat people’s mental health before their surgery. This might be why some people don’t recover as well as they should. What we want to do Our goal is to figure out which people with mental health problems, having knee replacements, are at highest risk of a bad result. The bad results we are interested in is patient happiness, pain and surgery complications. We believe that by looking at their mental health more carefully, using information collected by GP’s and community services, we can find these people and improve their experience. We are interested in 4 topics that have not been researched in detail: Does the specific mental health diagnosis matter? (e.g. - is anxiety or depression worse?) Does the severity of the MH problem matter? (e.g. – is severe depression worse than mild depression?) Does the timing of the mental health diagnosis matter? (e.g. – is a new diagnosis worse than a long-term issue?) What mental health treatments have been used before in surgery research? Do patients and healthcare workers think they are helpful and acceptable? How will we do the research? We will use healthcare data that is already collected in the UK from GP records, hospital data, and arthritis databases. The data will stay anonymous, so no one’s identity will be revealed. We will use computer models to help identify what makes a person more likely to have bad results after their surgery. We will then study previous research, to work out which Mental health treatments work best. We will then discuss the treatments with patients and healthcare workers to see if they are helpful and acceptable. How this will help This project will help identify people with mental health problems who are at the highest risk of not doing well after a knee replacement. Once we know who they are, we can work on treatments to help them recover better and feel happier after their surgery. This will help us to keep about 25,000 patients every year mobile, and healthy as they get older.