Education · recovery

Mind, Stress and Recovery Info Evidence

Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed

What you're feeling

At Mater Private Hospital Rockhampton, Dr Kieran Hirpara approaches your recovery by recognising that your mind and body are linked. We know that mental health plays a major role in how you heal. If you are dealing with anxiety or depression, your pain may feel more intense, and your recovery might take longer than expected. This is not a reflection of your strength; it is a biological reality we see in our clinic.

You might notice that your pain flares up at night or when you first wake up. Daily tasks that once felt simple can become difficult. You may find it hard to lift your arm to brush your hair, reach for a cup on a high shelf, or sleep comfortably on your side. These moments of frustration are common. They often stem from central sensitization, which is when your nervous system becomes overly reactive to normal signals. This can make even light touch or gentle movement feel painful.

We also see that stress and worry can amplify these physical sensations. If you have a history of chronic pain conditions, such as fibromyalgia, you may experience more severe symptoms than others. This does not mean the pain is 'in your head'; it means your nervous system is processing signals differently. In our practice, we monitor your mental well-being alongside your physical progress. We use standard tools to identify if you are at risk for a slower recovery. This allows us to support you holistically.

Your rehabilitation will be guided by your physiotherapist, who will help you manage these physical limits. However, we encourage you to also address any psychological distress. Ignoring anxiety or depression can lead to poorer outcomes and a higher risk of needing further care. By acknowledging these feelings, you give yourself the best chance to return to your daily activities with confidence. We are here to support you through every step of this journey.

What's actually happening

Your mind and body are deeply connected. When you face surgery, your mental health plays a major role in how well you recover. Unaddressed mental health issues can stop you from getting the full benefit of your procedure. This is true for hip preservation and joint replacement alike.

Think of your pain system like a home alarm. In some cases, the alarm becomes too sensitive. It reacts strongly to normal signals that shouldn’t cause pain. This is called central sensitization. It often happens when you have certain mental predispositions. Your nervous system stays on high alert. This makes your pain feel worse than the physical injury alone would explain.

Anxiety and depression change your recovery path. Patients with these symptoms often have inferior outcomes after total hip arthroplasty. Their recovery trajectory differs from those without these symptoms. New-onset anxiety or depression after shoulder stabilization surgery also increases your risk of being readmitted to the hospital within 90 days. Your mental state is the strongest link to how you feel before revision rotator cuff repairs.

We use specific tools to check your mental health before surgery. The Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-Score helps us identify who might have a harder time recovering. This tool is better than the Brief Resiliency Scale for spotting potential poor outcomes after elective total knee and hip arthroplasty.

Routine data from your preoperative care can also predict psychological distress. We look for these signs early. If you have fibromyalgia, even in remission, you may experience more severe symptoms and poorer quality of life than with rheumatoid arthritis. There is also a disparity between sexes in physical and psychological recovery after anterior cruciate ligament reconstruction.

We know that cognitive behavioral therapy can help with pain knowledge and psychological distress at 6 weeks. However, it did not yield meaningful benefits in pain and function out to 1 year for low back pain. This shows that mental support is complex. It requires careful attention to your individual needs. Your surgeon will consider these factors to guide your care.

What to expect

Your mental health plays a significant role in how you feel after orthopaedic surgery. Unaddressed mental health disorders can prevent you from achieving the best possible results. This means you might not reach the minimal level of improvement needed to feel a substantial benefit. Anxiety and depression symptoms are linked to inferior outcomes in procedures like total hip replacement. Your recovery path may differ if you experience these symptoms compared to those who do not.

We monitor your psychological well-being closely because it predicts how you will heal. Data collected during your routine preoperative care helps us identify potential distress early. Using tools like the Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-Score allows us to spot the potential for poor outcomes more effectively than other scales. This helps us tailor our support to your specific needs.

If you have conditions like fibromyalgia or rheumatoid arthritis, you may experience more severe symptoms and a lower quality of life than expected. In some cases, such as after shoulder stabilization surgery, developing new-onset anxiety or depression significantly increases your risk of being readmitted to the hospital within 90 days. For chronic low back pain, central sensitization can cause your nervous system to react excessively to normal stimuli, especially if you have certain mental predispositions.

While interventions like cognitive behavioral therapy may offer marginal improvements in pain knowledge and psychological distress at six weeks, they do not always yield meaningful benefits in pain and function out to one year. Physical and psychological recovery also varies between sexes, particularly in return to sport status after ligament reconstruction. We aim to manage these factors proactively. When mental health is supported, your recovery is smoother. When it is left unaddressed, persistent pain and limited function are more likely.


Evidence & references

Overview

  • Machine learning algorithms can predict psychological distress after total joint arthroplasty [1].
  • Early identification of patients at risk for postoperative psychological distress enables targeted behavioral health referral or psychologically informed physical therapy prior to surgery [1].
  • Anxiety and depression symptoms are associated with inferior outcomes in patients undergoing total hip arthroplasty [2].
  • Patients with anxiety and depression experience major clinical improvement after total hip arthroplasty but have different recovery trajectories [2].
  • Tailored perioperative counseling and psychological support are needed for patients with anxiety and depression undergoing total hip arthroplasty [2].
  • Patients with lower preoperative mental health scores report similar or greater pain improvements after regenerative peripheral nerve interface surgery for upper-extremity neuromas [3].
  • Patients with lower preoperative mental health scores report similar functional improvements after regenerative peripheral nerve interface surgery for upper-extremity neuromas [3].
  • Regenerative peripheral nerve interface surgery benefits patients regardless of mental health status [3].
  • Anxiety and depression may be more important than the alpha angle or suction seal in hip preservation surgery outcomes [4].
  • Unaddressed mental health disorders likely account for the persistent inability to achieve high rates of minimal clinically important difference and substantial clinical benefit in hip preservation surgery [4].
  • New-onset anxiety and depression occur in 5.1% of patients within 1 year following arthroscopic shoulder stabilization surgery [5].
  • There is a disparity between sexes in physical and psychological recovery, as well as return to sport status, in community-level patients undergoing anterior cruciate ligament reconstruction [6].
  • A cognitive behavioral therapy-based intervention resulted in marginal improvements in pain knowledge and psychological distress at 6 weeks for low back pain [8].
  • The cognitive behavioral therapy-based intervention did not yield meaningful benefits in pain and function out to 1 year for low back pain [8].
  • Patients with major depressive disorder and undiagnosed depression are at risk for inferior outcomes after patellar stabilization surgery [10].
  • Patients with underlying mental health disorders may still significantly benefit from medial patellofemoral ligament reconstruction compared to their unaffected counterparts [10].
  • Patients with underlying mental health disorders report worse pre- and post-operative PROMIS scores after medial patellofemoral ligament reconstruction compared to unaffected counterparts [10].
  • Kinesiophobia is a critical psychological factor that adversely affects functional recovery following arthroscopic Bankart repair [12].
  • Kinesiophobia is a critical psychological factor that adversely affects return to sport following arthroscopic Bankart repair [12].
  • The Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-Score has superior performance for identifying the potential for poor outcomes following elective total knee and hip arthroplasty [13].
  • The Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-Score is integrated within standard outcome frameworks [13].
  • The Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-Score is a valuable tool for preoperative psychosocial screening [13].

Anatomy & Pathophysiology

  • Machine learning models can predict psychological distress after total joint arthroplasty to enable early identification of at-risk patients [1].
  • Anxiety and depression symptoms are associated with inferior outcomes in patients undergoing total hip arthroplasty [2].
  • Patients with anxiety and depression experience major clinical improvement after total hip arthroplasty but have different recovery trajectories compared to those without these symptoms [2].
  • Patients with lower preoperative mental health scores report similar or greater pain improvements and similar functional improvements following regenerative peripheral nerve interface surgery for upper-extremity neuromas [3].
  • Unaddressed mental health disorders likely account for the persistent inability to achieve high rates of minimal clinically important difference and substantial clinical benefit in hip preservation surgery [4].
  • New-onset anxiety and depression occur in 5.1% of patients within 1 year following arthroscopic shoulder stabilization surgery [5].
  • There is a disparity between sexes in physical and psychological recovery, as well as return to sport status, in community-level patients undergoing anterior cruciate ligament reconstruction [6].
  • Revision rotator cuff repair patients are more commonly White, have lower mental health status, and have more severe rotator cuff pathology compared to primary rotator cuff repair patients [11].
  • Tear severity is not associated with baseline patient-reported outcomes in revision rotator cuff repair patients [11].
  • Kinesiophobia adversely affects functional recovery and return to sport following arthroscopic Bankart repair for glenohumeral instability [12].
  • A history of depression may not adversely affect patient-reported outcomes after thumb carpometacarpal arthroplasty [15].
  • Machine learning models demonstrate excellent predictive power and accuracy in assessing postoperative catastrophic cardiac complications following hip and knee periprosthetic fracture surgery using preoperative parameters [19].
  • Adding motor imagery to conservative treatment after distal radius fracture improves function, wrist extension, and hand grip strength compared to conventional treatment alone [20].
  • The Hip-RSI Score with a cutoff of 51.7 at 4 months postoperatively demonstrates moderate ability to predict return to sport after surgical repair of a proximal hamstring avulsion [21].
  • The Hip-RSI Score for predicting return to sport after proximal hamstring avulsion repair has a sensitivity of 69% and a specificity of 77% [21].
  • No operation for reconstruction of a resected part of the skeleton can restore a limb to normal function [22].
  • Patient-specific psychological characteristics and personality structure significantly affect functional outcomes after arthroscopically assisted acromioclavicular joint stabilization for acute and chronic injuries at mid-term follow-up [23].

Classification

  • Machine learning algorithms can predict psychological distress after total joint arthroplasty [1].
  • Anxiety and depression symptoms are associated with inferior outcomes in patients undergoing total hip arthroplasty [2].
  • Patients with lower preoperative mental health scores report similar or greater pain improvements and similar functional improvements following regenerative peripheral nerve interface surgery for upper-extremity neuromas [3].
  • Unaddressed mental health disorders likely account for the persistent inability to achieve high rates of minimal clinically important difference and substantial clinical benefit in hip preservation surgery [4].
  • New-onset anxiety and depression occur in 5.1% of patients within 1 year following arthroscopic shoulder stabilization surgery [5].
  • There is a disparity between sexes in physical and psychological recovery, as well as return to sport status, in community-level patients undergoing anterior cruciate ligament reconstruction [6].
  • Patients with remission or mild fibromyalgia experience more severe symptoms and poorer quality of life than patients with remission or low disease activity rheumatoid arthritis [7].
  • Patients with major depressive disorder and undiagnosed depression are at risk for inferior outcomes after patellar stabilization surgery [10].
  • Patients with underlying mental health disorders report worse pre- and post-operative PROMIS scores after MPFL-R compared to unaffected counterparts [10].
  • Revision rotator cuff repair patients have lower mental health status compared to primary rotator cuff repair patients [11].
  • Tear severity is not associated with baseline PROMs in revision rotator cuff repair patients [11].
  • The Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-Score is a valuable tool for preoperative psychosocial screening for poor outcomes following elective total knee and hip arthroplasty [13].
  • Adolescent AIS patients' anxiety levels are stable, independent of received therapeutic support [14].
  • Central sensitization in chronic nonspecific low back pain can be seen as an excessive reactivity of nociceptive neurons in the central nervous system to normal or subthreshold afferent chronic stimuli in people with certain mental predispositions [16].

Clinical Presentation

  • Machine learning algorithms can predict psychological distress after total joint arthroplasty [1].
  • Anxiety and depression symptoms are associated with inferior outcomes in patients undergoing total hip arthroplasty [2].
  • Patients with lower preoperative mental health scores report similar or greater pain improvements and similar functional improvements following regenerative peripheral nerve interface surgery for upper-extremity neuromas [3].
  • Unaddressed mental health disorders likely account for the persistent inability to achieve high rates of minimal clinically important difference and substantial clinical benefit in hip preservation surgery [4].
  • New-onset anxiety and depression occur in 5.1% of patients within 1 year following arthroscopic shoulder stabilization surgery [5].
  • There is a disparity between sexes in physical and psychological recovery, as well as return to sport status, in community-level patients undergoing anterior cruciate ligament reconstruction [6].
  • Patients with remission or mild fibromyalgia experience more severe symptoms and poorer quality of life than patients with remission or low disease activity rheumatoid arthritis [7].
  • A cognitive-behavioral therapy-based intervention resulted in marginal improvements in pain knowledge and psychological distress at 6 weeks for low back pain, but did not yield meaningful benefits in pain and function out to 1 year [8].
  • Patients with major depressive disorder and undiagnosed depression are at risk for inferior outcomes after patellar stabilization surgery [10].
  • Patients with underlying mental health disorders report worse pre- and post-operative PROMIS scores after MPFL-R compared to unaffected counterparts [10].
  • Revision rotator cuff repair cohorts have lower mental health status compared to primary rotator cuff repair cohorts [11].
  • Tear severity was not associated with baseline PROMs in patients undergoing revision rotator cuff repairs [11].
  • Kinesiophobia adversely affects functional recovery and return to sport following arthroscopic Bankart repair [12].
  • The Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-Score is a valuable tool for preoperative psychosocial screening for potential poor outcomes following elective total knee and hip arthroplasty [13].
  • Adolescent idiopathic scoliosis patients' anxiety levels are stable, independent of received therapeutic support [14].
  • Central sensitization in chronic nonspecific low back pain can be seen as an excessive reactivity of nociceptive neurons in the central nervous system to normal or subthreshold afferent chronic stimuli in people with certain mental predispositions [16].

Investigations

  • Machine learning algorithms can predict psychological distress after total joint arthroplasty [1].
  • Such models support early identification of patients at risk for postoperative psychological distress [1].
  • Early identification enables targeted behavioral health referral prior to surgery [1].
  • Early identification enables psychologically informed physical therapy prior to surgery [1].
  • Anxiety and depression symptoms are associated with inferior outcomes in patients undergoing total hip arthroplasty [2].
  • Patients with anxiety and depression experience major clinical improvement after total hip arthroplasty [2].
  • Patients with anxiety and depression have different recovery trajectories after total hip arthroplasty [2].
  • Tailored perioperative counseling is needed for patients with anxiety and depression undergoing total hip arthroplasty [2].
  • Psychological support is needed for patients with anxiety and depression undergoing total hip arthroplasty [2].
  • Patients with lower preoperative mental health scores report similar or greater pain improvements after regenerative peripheral nerve interface surgery [3].
  • Patients with lower preoperative mental health scores report similar functional improvements after regenerative peripheral nerve interface surgery [3].
  • Regenerative peripheral nerve interface benefits patients regardless of mental health status [3].
  • Anxiety and depression may be more important than the alpha angle or suction seal in hip preservation surgery outcomes [4].
  • Unaddressed mental health disorders likely account for the persistent inability to achieve high rates of minimal clinically important difference in hip preservation surgery [4].
  • Unaddressed mental health disorders likely account for the persistent inability to achieve substantial clinical benefit in hip preservation surgery [4].
  • New-onset anxiety and depression occur in 5.1% of patients within 1 year following arthroscopic shoulder stabilization surgery [5].
  • There is a disparity between sexes in physical recovery following anterior cruciate ligament reconstruction [6].
  • There is a disparity between sexes in psychological recovery following anterior cruciate ligament reconstruction [6].
  • There is a disparity between sexes in return to sport status following anterior cruciate ligament reconstruction [6].
  • Patients with remission or mild fibromyalgia experience more severe symptoms than patients with remission or low disease activity rheumatoid arthritis [7].
  • Patients with remission or mild fibromyalgia experience poorer quality of life than patients with remission or low disease activity rheumatoid arthritis [7].
  • Patients with remission or mild fibromyalgia experience more severe symptoms than healthy controls [7].
  • Patients with remission or mild fibromyalgia experience poorer quality of life than healthy controls [7].
  • A cognitive-behavioral therapy-based intervention resulted in marginal improvements in pain-related knowledge at 6 weeks for low back pain [8].
  • A cognitive-behavioral therapy-based intervention resulted in marginal improvements in psychological distress at 6 weeks for low back pain [8].
  • A cognitive-behavioral therapy-based intervention did not yield meaningful benefits in pain out to 1 year for low back pain [8].
  • A cognitive-behavioral therapy-based intervention did not yield meaningful benefits in function out to 1 year for low back pain [8].
  • Patients with major depressive disorder are at risk for inferior outcomes after patellar stabilization surgery [10].
  • Patients with undiagnosed depression are at risk for inferior outcomes after patellar stabilization surgery [10].
  • Patients with underlying mental health disorders report worse pre-operative PROMIS scores after MPFL-R compared to unaffected counterparts [10].
  • Patients with underlying mental health disorders report worse post-operative PROMIS scores after MPFL-R compared to unaffected counterparts [10].
  • Patients with underlying mental health disorders may still significantly benefit from MPFL-R compared to their unaffected counterparts [10].
  • Revision rotator cuff repair patients are more commonly White than primary rotator cuff repair patients [11].
  • Revision rotator cuff repair patients have lower mental health status than primary rotator cuff repair patients [11].
  • Revision rotator cuff repair patients have more severe rotator cuff pathology than primary rotator cuff repair patients [11].
  • Tear severity was not associated with baseline PROMs in revision rotator cuff repair patients [11].
  • Kinesiophobia adversely affects functional recovery following arthroscopic Bankart repair [12].
  • Kinesiophobia adversely affects return to sport following arthroscopic Bankart repair [12].
  • The Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-Score has superior performance for identifying the potential for poor outcomes following elective total knee and hip arthroplasty [13].
  • The Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-Score is integrated within standard outcome frameworks [13].
  • The Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-Score is a valuable tool for preoperative psychosocial screening [13].
  • Adolescent idiopathic scoliosis patients' anxiety levels are stable independent of received therapeutic support [14].
  • Music therapy intervention effects on pain and anxiety in adult patients undergoing total shoulder arthroplasty were not dependent on live vs. recorded presentation [17].
  • Adding motor imagery to conservative treatment after distal radius fracture improved function compared to conventional treatment alone [20].
  • Adding motor imagery to conservative treatment after distal radius fracture improved wrist extension compared to conventional treatment alone [20].
  • Adding motor imagery to conservative treatment after distal radius fracture improved hand grip strength compared to conventional treatment alone [20].

Treatment

  • Machine learning algorithms can predict psychological distress after total joint arthroplasty to support early identification of at-risk patients [1].
  • Early identification of patients at risk for postoperative psychological distress enables targeted behavioral health referral or psychologically informed physical therapy prior to surgery [1].
  • Anxiety and depression symptoms are associated with inferior outcomes in patients undergoing total hip arthroplasty [2].
  • Patients with anxiety and depression experience major clinical improvement after total hip arthroplasty but have different recovery trajectories [2].
  • The differing recovery trajectories of patients with anxiety and depression emphasize the need for tailored perioperative counseling and psychological support [2].
  • Regenerative peripheral nerve interface (RPNI) surgery provides similar or greater pain improvements and similar functional improvements regardless of preoperative mental health status [3].
  • Unaddressed mental health disorders likely account for the persistent inability to achieve high rates of minimal clinically important difference and substantial clinical benefit in hip preservation surgery [4].
  • New-onset anxiety and depression occur in 5.1% of patients within 1 year following arthroscopic shoulder stabilization surgery [5].
  • Sex-based disparities exist in physical and psychological recovery, as well as return to sport status, in community-level patients undergoing anterior cruciate ligament reconstruction [6].
  • Patients with remission or mild fibromyalgia experience more severe symptoms and poorer quality of life than patients with remission or low disease activity rheumatoid arthritis [7].
  • A cognitive-behavioral therapy-based intervention resulted in marginal improvements in pain knowledge and psychological distress at 6 weeks for low back pain but did not yield meaningful benefits in pain and function out to 1 year [8].
  • Distal biceps tendon repair using a cortical button with or without an interference screw provides excellent short- to mid-term clinical and functional outcomes [9].
  • Patients with major depressive disorder and undiagnosed depression report worse pre- and post-operative PROMIS scores after patellar stabilization surgery compared to unaffected counterparts [10].
  • Patients with underlying mental health disorders may still significantly benefit from medial patellofemoral ligament reconstruction compared to their unaffected counterparts [10].
  • Kinesiophobia is a critical psychological factor that adversely affects functional recovery and return to sport following arthroscopic Bankart repair [12].
  • The Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-Score is a valuable tool for preoperative psychosocial screening due to its superior performance and integration within standard outcome frameworks [13].
  • Adolescent idiopathic scoliosis patients' anxiety levels are stable and independent of received therapeutic support [14].
  • Music therapy intervention effects on pain and anxiety in adult patients undergoing total shoulder arthroplasty were not dependent on live versus recorded presentation [17].

Complications

  • Machine learning algorithms can predict psychological distress after total joint arthroplasty [1].
  • Early identification of patients at risk for postoperative psychological distress enables targeted behavioral health referral or psychologically informed physical therapy prior to surgery [1].
  • Anxiety and depression symptoms are associated with inferior outcomes in patients undergoing total hip arthroplasty [2].
  • Patients with anxiety and depression experience major clinical improvement after total hip arthroplasty but have different recovery trajectories [2].
  • Tailored perioperative counseling and psychological support are needed for patients with anxiety and depression undergoing total hip arthroplasty [2].
  • Patients with lower preoperative mental health scores report similar or greater pain improvements after regenerative peripheral nerve interface (RPNI) surgery for upper-extremity neuromas [3].
  • Patients with lower preoperative mental health scores report similar functional improvements after RPNI surgery for upper-extremity neuromas [3].
  • RPNI benefits patients regardless of mental health status [3].
  • Unaddressed mental health disorders likely account for the persistent inability to achieve high rates of minimal clinically important difference and substantial clinical benefit in hip preservation surgery [4].
  • Anxiety and depression may be more important than the alpha angle or suction seal in hip preservation surgery outcomes [4].
  • New-onset anxiety and depression occur in 5.1% of patients within 1 year following arthroscopic shoulder stabilization surgery [5].
  • There is a disparity between sexes in physical and psychological recovery, as well as return to sport status, in community-level patients undergoing anterior cruciate ligament reconstruction (ACLR) [6].
  • Patients with remission or mild fibromyalgia experience more severe symptoms and poorer quality of life than patients with remission or low disease activity rheumatoid arthritis [7].
  • A cognitive behavioral therapy (CBT)-based intervention resulted in marginal improvements in pain knowledge and psychological distress at 6 weeks for low back pain [8].
  • The CBT-based intervention did not yield meaningful benefits in pain and function out to 1 year for low back pain [8].
  • Risk-stratified care improves pain-related knowledge and reduces psychological distress for low back pain [8].
  • Patients with major depressive disorder and undiagnosed depression are at risk for inferior outcomes after patellar stabilization surgery [10].
  • Patients with underlying mental health disorders report worse pre- and post-operative PROMIS scores after MPFL-R compared to unaffected counterparts [10].
  • Patients with underlying mental health disorders may still significantly benefit from MPFL-R compared to their unaffected counterparts [10].
  • Revision rotator cuff repair (RCR) patients are more commonly White than primary RCR patients [11].
  • Revision RCR patients have lower mental health status than primary RCR patients [11].
  • Revision RCR patients have more severe rotator cuff pathology than primary RCR patients [11].
  • Tear severity was not associated with baseline PROMs in revision RCR patients [11].
  • A history of depression may not adversely affect patient-reported outcomes after thumb carpometacarpal (CMC) arthroplasty [15].
  • A history of anxiety and/or depression is consistently associated with poorer outcomes after arthroscopic hip surgery at 2-year follow-up [18].
  • Resilience demonstrates a less consistent and variable association with outcomes after arthroscopic hip surgery [18].
  • Machine learning models demonstrate excellent predictive power and accuracy in assessing postoperative cardiac complications following hip and knee periprosthetic fracture surgery using preoperative parameters [19].

Recovery

  • Machine learning algorithms can predict psychological distress after total joint arthroplasty to support early identification of at-risk patients [1].
  • Early identification of postoperative psychological distress risk enables targeted behavioral health referral or psychologically informed physical therapy prior to surgery [1].
  • Anxiety and depression symptoms are associated with inferior outcomes in patients undergoing total hip arthroplasty [2].
  • Patients with anxiety and depression experience major clinical improvement after total hip arthroplasty but have different recovery trajectories [2].
  • The differing recovery trajectories of patients with anxiety and depression emphasize the need for tailored perioperative counseling and psychological support [2].
  • Patients with lower preoperative mental health scores report similar or greater pain improvements after regenerative peripheral nerve interface (RPNI) surgery for upper-extremity neuromas [3].
  • Patients with lower preoperative mental health scores report similar functional improvements after RPNI surgery for upper-extremity neuromas [3].
  • RPNI benefits patients regardless of mental health status [3].
  • Unaddressed mental health disorders likely account for the persistent inability to achieve high rates of minimal clinically important difference and substantial clinical benefit in hip preservation surgery [4].
  • New-onset anxiety and depression occur in 5.1% of patients within 1 year following arthroscopic shoulder stabilization surgery [5].
  • There is a disparity between sexes in physical and psychological recovery, as well as return to sport status, in community-level patients undergoing anterior cruciate ligament reconstruction (ACLR) [6].
  • Patients with remission or mild fibromyalgia experience more severe symptoms and poorer quality of life than patients with remission or low disease activity rheumatoid arthritis [7].
  • A cognitive behavioral therapy (CBT)-based intervention resulted in marginal improvements in pain knowledge and psychological distress at 6 weeks for low back pain [8].
  • The CBT-based intervention for low back pain did not yield meaningful benefits in pain and function out to 1 year [8].
  • Revision rotator cuff repair patients are more commonly White than primary rotator cuff repair patients [11].
  • Revision rotator cuff repair patients have lower mental health status than primary rotator cuff repair patients [11].
  • Revision rotator cuff repair patients have more severe rotator cuff pathology than primary rotator cuff repair patients [11].
  • Tear severity was not associated with baseline patient-reported outcome measures (PROMs) in revision rotator cuff repair patients [11].
  • Kinesiophobia is a critical psychological factor that adversely affects functional recovery following arthroscopic Bankart repair for glenohumeral instability [12].
  • Kinesiophobia is a critical psychological factor that adversely affects return to sport following arthroscopic Bankart repair for glenohumeral instability [12].
  • A history of depression may not adversely affect patient-reported outcomes after thumb carpometacarpal (CMC) arthroplasty [15].
  • A history of anxiety and/or depression is consistently associated with poorer outcomes after arthroscopic hip surgery at 2-year follow-up [18].
  • Resilience demonstrates a less consistent and variable association with outcomes after arthroscopic hip surgery [18].

Key Evidence

  • [L4] Such models could support early identification of patients at risk for postoperative psychological distress, enabling targeted behavioral health referral or psychologically informed physical therapy prior to surgery. [1] (10.1016/j.arth.2026.05.039)
  • [L2] While these patients experience major clinical improvement after THA, their recovery trajectories differ, emphasizing the need for tailored perioperative counseling and psychological support. [2] (10.1016/j.arth.2025.06.013)
  • [L4] Patients with lower preoperative mental health scores reported similar or greater pain improvements and similar functional improvements, suggesting RPNI benefits patients regardless of mental health status. [3] (10.1016/j.jhsg.2026.100985)
  • [L5] Unaddressed mental health disorders likely account for the persistent inability to achieve high rates of minimal clinically important difference and substantial clinical benefit in hip preservation surgery. [4] (10.1002/arj.70034)
  • [L3] New-onset anxiety and depression occur in 5.1% of patients within 1 year following arthroscopic shoulder stabilization surgery. [5] (10.1016/j.jseint.2025.101413)
  • [L2] This study demonstrates the disparity between sexes in physical and psychological recovery, as well as RTS status, in community-level patients undergoing ACLR. [6] (10.1177/2325967125s00328)
  • [L4] Despite being in a mild activity or remission stage, RFM patients experience more severe symptoms and poorer QOL than RRA patients. [7] (10.1186/s12891-025-08323-6)
  • [Paper] This CORR Insights commentary discusses a secondary analysis of a randomized trial, noting that while a CBT-based intervention resulted in marginal improvements in pain knowledge and psychological distress at 6 weeks, it did not yield meaningful benefits in pain and function out to 1 year. [8] (10.1097/corr.0000000000003410)
  • [L3] Both techniques provided excellent short- to mid-term clinical and functional outcomes. [9] (10.1177/17585732261441889)
  • [L3] Patients with underlying mental health disorders may still significantly benefit from MPFL-R compared to their unaffected counterparts but will nonetheless report worse pre- and post-operative PROMIS scores. [10] (10.1016/j.jisako.2026.101080)
  • [L3] Compared to primary RCR patients, the revision cohort were more commonly White, had lower mental health status and more severe rotator cuff pathology, though tear severity was not associated with baseline PROMs. [11] (10.1016/j.jse.2026.05.007)
  • [L3] Kinesiophobia is a critical psychological factor that adversely affects functional recovery and return to sport following arthroscopic Bankart repair. [12] (10.1186/s12891-026-09567-6)
  • [L3] Its superior performance and integration within standard outcome frameworks make it a valuable tool for preoperative psychosocial screening. [13] (10.1016/j.arth.2025.09.034)
  • [L3] AIS patients' anxiety levels are stable, independent of received therapeutic support. [14] (10.1186/s12891-026-09645-9)
  • [L4] These findings suggest that a history of depression may not adversely affect patient-reported outcomes after thumb CMC arthroplasty. [15] (10.1016/j.jhsg.2026.100989)
  • [L5] Central sensitization can be seen as an excessive reactivity of nociceptive neurons in the central nervous system to normal or subthreshold afferent chronic stimuli in people with certain mental predispositions. [16] (10.3390/jcm14020577)
  • [L2] Findings were not dependent on live vs. recorded presentation. [17] (10.1016/j.jseint.2025.101438)
  • [L3] The present study suggests that a history of anxiety and/or depression is consistently associated with poorer outcomes after arthroscopic hip surgery, whereas resilience demonstrates a less consistent and variable association. [18] (10.1177/23259671251407329)
  • [L3] All models demonstrated excellent predictive power and accuracy in assessing postoperative cardiac complications. [19] (10.1016/j.arth.2026.04.007)
  • [L1] Adding motor imagery to conservative treatment after distal radius fracture improved function, wrist extension, and hand grip strength compared to conventional treatment alone. [20] (10.1016/j.jht.2025.02.018)
  • [L3] This score, with a cutoff of 51.7 at 4 months postoperatively, demonstrated a moderate ability to predict which patients would return to sport, with a sensitivity of 69% and a specificity of 77%. [21] (10.1177/23259671251389118)
  • [Paper] No operation for reconstruction of a resected part of the skeleton can restore a limb to normal function. [22] (10.2106/00004623-196446020-00012)
  • [L4] Patient-specific psychological characteristics and personality structure significantly affect functional outcomes after arthroscopically assisted ACJ stabilization for acute and chronic ACJ injuries at mid-term follow-up. [23] (10.1002/ksa.70349)

References

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