Comorbid depression and anxiety impact hip osteoarthritis disability

Ray Marks, Ed.D.

Departments of Health, Physical Education & Gerontological Studies and Services, City University of New York, York College, and Health and Behavior Studies, Columbia University, Teachers College, New York, NY 10027, USA

Disability and Health Journal,  January 2009 Volume 2, Issue 1, Pages 27–35




Hip osteoarthritis, a common age-associated condition, produces considerable disability that may be influenced by a variety of factors other than age. This study examines the magnitude and impact of the presence of comorbid and/or concurrent depression and anxiety symptoms on the disability experienced before and immediately after total hip replacement surgery for end-stage osteoarthritis—a very understudied, albeit potentially important area for improving the health and well-being of adults with this disabling condition.


The available records of 1,000 hip osteoarthritis surgical candidates were examined for any historical/concurrent evidence of depression/anxiety. Additional data on medical comorbidities, pain, function, and discharge destination were extracted. Selected subgroup comparisons between those with depression and anxiety disorder histories and those with no such history and their preoperative and immediate postoperative functional outcomes were conducted.


(1) Nine percent (90 patients) of the cohort reported having a prior mood disorder. An additional 9% reported anxiety symptoms and 0.8% reported feeling depressed prior to surgery. (2) Those with depression and anxiety histories were more impaired before surgery and tended to recover more slowly than those with no such history (p < .001). (3) Discharge destination, a surrogate functional measure, varied with the presence or absence of a depression or anxiety history.


Almost 20% of end-stage hip osteoarthritis cases undergoing replacement surgery may have mood disorder histories and/or prevailing symptoms of emotional distress that may exaggerate preoperative hip osteoarthritis disability and slow the postoperative recovery process. Examining the cognitive as well as the physical status of adults undergoing hip replacement surgery for osteoarthritis and individualizing, rather than promoting generic intervention approaches, is indicated in efforts to optimize outcomes and minimize impairments and disability for adults with this condition.


Anxiety, Depression, Disability, Hip osteoarthritis, Surgery