Do patient personality traits influence total joint arthroplasty outcomes? A systematic review.

BACKGROUND

Outcomes after total joint arthroplasty are influenced by various biopsychosocial factors, among which preoperative psychological status and personality traits play a crucial role. Given that personality traits - such as extroversion, psychoticism, anxiety, and neuroticism - represent a wider, enduring framework compared to transient mental states like depression and stress, their impact on surgical outcomes is significant. This systematic review aims to evaluate the influence of personality traits on clinical outcomes after total joint arthroplasty.

METHODS

PubMed, Web of Science, Scopus, and Embase were explored from initiation until May 2025. The inclusion terms were "personality traits," "total knee arthroplasty," and "total hip arthroplasty," along with related MeSH terms, with no boundaries for language. Backward reference citation searches were also conducted.

RESULTS

Finally, a total of 15 studies were included. Anxiety is one of the most substantial factors impacting the consequences of total joint arthroplasty. Although there is unsatisfactory evidence supporting pain reduction in extroverted individuals, extroversion has been associated with improved quality of life and postoperative functional outcomes. Additionally, neuroticism has a negative correlation with quality of life and is linked to increased pain levels. Pessimism is associated with greater pain, reduced knee function improvement, and increased activity limitations. Based on quality-of-life questionnaires, extroversion and melancholic traits were associated with higher scores. However, neuroticism showed a negative correlation with Short Form (SF)-36 scores.

CONCLUSIONS

Pain was the most significant assessed outcome. A positive association was observed between pain and traits such as extroversion, neuroticism, pessimism, anxiety, depression, and persistence. Concerning quality of life, features like extroversion and melancholic temperament were associated with higher quality of life, whereas neuroticism had a negative correlation with SF-36. Based on these findings, considering personality and psychological factors can contribute to improving surgical outcomes, and preoperative counseling is recommended.