Association of General Personality Traits with Outcomes in Total Hip Arthroplasty: A Multicenter, Cross-Sectional, Prospective Trial.

BACKGROUND

The influence of psychological traits such as depression on postoperative outcomes after total hip arthroplasty (THA) is known, but data on general personality traits, such as optimism and pessimism, remain scarce. Understanding the impact of optimism and pessimism on postoperative outcomes in THA patients could provide valuable insights for preoperative patient assessments and postoperative care strategies. We hypothesized that patients with higher levels of optimism would demonstrate superior functional outcomes and that the opposite applies to pessimistic patients.

METHODS

A prospective, multicenter, cross-sectoral study assessed the association of personality traits with preoperative and 3, 6, and 12-month postoperative functional scores (12-item Hip Disability and Osteoarthritis Outcome Score [HOOS-12]). Optimism and pessimism were measured preoperatively via the revised Life Orientation Test (LOT-R). Linear regression models were fitted, and coefficients of determination (R2) and t-tests were obtained to reveal the correlation and statistical significance of the associations. The study was recorded in the German Clinical Trials Register (DRKS00013972).

RESULTS

Eight hundred forty-six patients were analyzed. Optimism was significantly associated with HOOS-12 scores over the first postoperative year, whereas pessimism was significantly associated for 6- and 12-month follow-up (preoperative: optimistic r = 0.11, p = 0.018; pessimistic r = 0.07, p = 0.099; postoperative optimistic: 3 months r = 0.143, p = 0.005; 6 months r = 0.148, p = 0.013; 12 months r = 0.121, p = 0.049; postoperative pessimistic: 3 months r = 0.090, p = 0.070; 6 months r = 0.155, p = 0.010; 12 months r = 0.165, p = 0.008).

CONCLUSIONS

Optimism and pessimism are opposing and significantly associated with postoperative outcomes after THA, although not reaching the minimal clinically important change of the HOOS-12 score. If patients scheduled for THA seem prone to pessimistic behavior, further screening of the patient's personality traits and other risk factors should be conducted. The outcomes of these patients could be improved through psychoeducation or cognitive behavioral interventions.