Depression and anxiety before and after limb length discrepancy correction in patients with unilateral developmental dysplasia of the hip

https://doi.org/10.1016/j.jpsychores.2015.08.002Get rights and content

Highlights

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    Depression and anxiety levels before THA were significantly higher in DDH patients with perceived LLD than in those with non-perceived LLD.

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    In patients with LLD, perception of LLD changed dynamically after it was corrected.

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    Changes in the perception of LLD play an essential role in the improvement of depression and anxiety in DDH patients with perceived LLD.

Abstract

Objective

Limb length discrepancy (LLD) is common in patients with developmental dysplasia of the hip (DDH) and may influence the psychological status of these patients. The present study aims to investigate depression and anxiety in DDH patients with different extents of LLD and to assess the effect of LLD correction on these two psychological factors.

Methods

161 patients with DDH were recruited and divided into two groups based on whether they could perceive LLD preoperatively. The patients who could not perceive LLD were assigned to group N, and those who could perceive LLD were assigned to group P. Depression/anxiety, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and LLD were assessed one week before, six months and two years after total hip arthroplasty (THA).

Results

Depression and anxiety were significantly higher in group P patients compared to group N patients. The patients in group N presented significant improvement in depression and anxiety six months after arthroplasty, while DDH patients in group P did two years after arthroplasty. Correlation analyses revealed their improvement was associated with pain relief and improved hip function in both groups of patients and was also related to changes in the perception of LLD in group P patients.

Conclusions

Depression and anxiety levels were higher in DDH patients with perceived LLD. Their improvement was related to pain relief and improved hip function following THA. In DDH patients with perceived LLD, a change in the perception of LLD also played a part in their improvement.

Introduction

Developmental dysplasia of the hip (DDH) is a common congenital skeletal anomaly. The incidence of DDH varies from 0.1% to 1.84% in the Caucasian population and 0.1%–0.5% in the Chinese population [1]. Persistent DDH can induce chronic hip pain and dysfunction and increase hip osteoarthritis risk [2]. In DDH patients, total hip arthroplasty (THA) has been considered the most successful intervention for secondary hip osteoarthritis, as it relieves pain and improves hip function and quality of life [3], [4], [5], [6]. However, patients' psychological status plays an important role in their satisfaction with the intervention. Studies have reported the influence of psychological factors in patients undergoing total knee arthroplasty (TKA) and THA [3], [4]. Patients with higher depression and anxiety often report lower satisfaction with these surgical treatments [5], [6]. The evaluation of patients' preoperative psychological status helps predict their satisfaction with the orthopedic outcomes of THA and serves as the basis for psychological intervention during treatment.

Studies have reported significant improvements in health-related quality of life after orthopedic surgery in patients with DDH [7], [8], [9]. However, the psychological status of patients before and after arthroplasty is less frequently described. Long-term psychological adjustment has been reported for children treated for congenital dislocation of the hip [10], and the psychological characteristics of patients with congenital dislocation of the hip who were treated with THA has also been described [11]. Depression and anxiety following THA has also been examined in patients with DDH [8]. However, the authors did not take into consideration the variation in disease severity among the patients. Patients with DDH suffer from different degrees of dislocation, ranging from hip dysplasia to hip dislocation. The level of pain, the physical function of the hip and the limb length discrepancy (LLD) that results from hip dislocation may also vary.

LLD could be perceived or not by patients. DDH patients with non-perceived LLD experience pain and hip dysfunction caused by secondary osteoarthritis in their 30s or 40s. DDH patients with perceived LLD suffer perceived LLD from birth, which later presents as a limp, and the patients suffer severe pain and limited hip motion from secondary osteoarthritis. Pain and hip dysfunction are believed to affect patients' quality of life and psychological status [12]. Because perceived LLD can influence patients' daily lives [13], we speculated that LLD might exert a negative effect on patients' psychological status. Furthermore, patients with DDH exhibit different degrees of LLD; thus, their psychological status might differ.

The effects of LLD that arise after THA have been extensively studied [14], [15], [16], [17] and have been demonstrated to influence patients' satisfaction and quality of life. LLD, which is congenital in patients with DDH, can be fully or partially corrected by THA when secondary hip osteoarthritis occurs. How preoperative LLD correction influences depression and anxiety and changes the perception of LLD is rarely reported. The aim of this study was to investigate the depression and anxiety status of DDH patients with perceived and non-perceived LLD before and after THA and to assess the effects of LLD correction by THA on patients' psychological status.

Section snippets

Patients

The study was a prospective cohort study, and the patients were recruited from two major hospitals. Patients with unilateral DDH who underwent primary THA between March 2008 and August 2010 in these two hospitals were recruited. The indications for THA were severe hip pain or limited mobility. The inclusion criteria were as follows: primary THA for unilateral DDH patients, over 18 years of age, intellectual and linguistic ability to complete questionnaires. The exclusion criteria were as

Results

One hundred sixty-one patients (29 males and 132 females) were recruited in the study and completed the questionnaire before surgery. Eighty patients were categorized as group N; and 81, as group P. There were no significant differences with respect to sex ratio, age or BMI between the two groups (p < 0.05) (Table 1). Fig. 1 presents a flow chart that illustrates the study procedures and population. The reproducibility of the LLD measurements was acceptable; the inter-observer correlation

Preoperative depression and anxiety

Psychological evaluations have identified higher incidences of depression and anxiety in adolescents undergoing hip preservation surgery [26], individuals with a history of Legg–Calve–Perthes Disease [27], and patients with primary hip osteoarthritis [5] compared to the general population. However, the psychological status of patients with DDH is rarely reported. This study found that DDH patients with perceived LLD exhibited a higher degree of depression and anxiety, including trait anxiety

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