Mental health and joint replacement are connected in ways most patients never hear about before surgery. I have performed hip and knee replacements for more than twenty years, and I now do more than 700 a year at the Bone and Joint Institute of Tennessee in Franklin.
The X-ray tells me a lot about the joint. It tells me nothing about how the person attached to it is sleeping, coping, or feeling. I say this to patients often: your mind goes into the operating room with you, and it shows up for every day of recovery too.
None of this is about blame. Depression and anxiety are medical conditions, just like arthritis.
What Are the 5 Essential Facts About Mental Health and Joint Replacement?
The five facts: mood problems are common with arthritis, they can affect surgical results, surgery often improves mood, a diagnosis rarely rules you out, and preparation helps.
- It is common. In one European study, about one in three hip patients and nearly one in four knee patients had depressive symptoms before surgery.
- It can affect results. Depression and anxiety are linked with more pain, longer hospital stays, and more repeat surgery.
- Surgery often helps mood. When constant pain goes away, anxiety and depressive symptoms ease for many patients.
- A diagnosis rarely rules you out. Most patients with well-managed depression or anxiety do very well.
- Preparation works on the mind too. Mood, sleep, support, and expectations can all be improved before surgery.
How Do Depression and Anxiety Affect Hip and Knee Replacement Results?
Depression and anxiety are linked with more pain after surgery, slower early recovery, lower satisfaction, and a modestly higher risk of complications and repeat surgery. The new joint itself usually works fine; the difference shows up in how recovery goes and how the patient feels about the result.
After more than twenty years doing this, I have seen the pattern many times. Two patients can have the same operation and the same perfect X-ray. One is thrilled at six weeks; the other is frightened, worn out, and sure something is wrong.
What does the research on mental health and joint replacement show?
The research shows a consistent link between mental health and joint replacement outcomes, though it cannot prove that one causes the other. The largest review, published in 2025, pooled 23 studies and more than 4.6 million hip and knee replacement patients.
Patients with depression had a 32 percent higher relative risk of revision surgery, which means a second operation to repair or replace the implant. The link was stronger for hips (49 percent) than for knees (17 percent).
A Medicare study of more than 675,000 hip replacement patients found that those with depression, bipolar disorder, or schizophrenia were more likely to have 13 of the 14 complications studied. A Cleveland Clinic study of more than 7,000 knee replacement patients found that low mental health scores before surgery meant longer hospital stays and nearly twice the odds of going to a rehab facility instead of home.
Keep those numbers in perspective. A higher relative risk is not a high risk. Revision surgery is uncommon, and most patients with depression or anxiety never need one.
Why would mood change how a new joint performs?
Mood changes how a person feels pain, how much they move, and how well they can follow a recovery plan.
- Pain runs louder. Depression and anxiety turn up the volume on pain signals.
- Movement drops. Less walking means more stiffness, more weakness, and a higher chance of a fall.
- Sleep suffers. Poor sleep makes pain harder to tolerate.
- Other health problems travel along. Depression often comes with diabetes, smoking, or extra weight, and each raises surgical risk.
There is also a thinking pattern called pain catastrophizing: a habit of expecting the worst from pain and focusing on it constantly. Studies link it with more lasting pain after knee replacement. It is a habit, and habits can be changed.
Does Joint Replacement Improve Mental Health?
Yes, for many patients it does. When arthritis pain goes away and walking, sleeping, and seeing friends become possible again, anxiety and depressive symptoms often ease.
In a Dutch study, depressive symptoms among knee replacement patients fell from about 23 percent before surgery to about 12 percent twelve months later. A Canadian study of hip replacement patients found that average mental health scores rose from 72 to 81 (on a 100-point scale) one year after surgery.
I see this in my clinic every week. Chronic pain shrinks a person’s world, and joint pain and mental health feed each other. Fixing the joint often breaks that cycle.
There is an honest caveat. In that same Dutch study, patients who started with anxiety or depressive symptoms improved, but they were less satisfied at one year than patients who started without them. A new joint helps; it is not a treatment for depression by itself.
Should You Delay Hip or Knee Replacement Because of Depression or Anxiety?
Usually not. A mental health diagnosis by itself is rarely a reason to cancel or avoid joint replacement. What matters is whether the condition is stable and whether you have support for recovery.
In my practice, I think about mental health and joint replacement the same way I think about blood sugar, blood pressure, or smoking. It is one more thing we want in the best possible shape before surgery.
Sometimes a short delay is the right call. If a patient is in a severe depressive episode or has no one at home to help, I would rather wait a few weeks. Joint replacement is elective, so we get to pick the day.
Early research supports this approach. Treating depression before surgery has been linked with better short-term pain and function, and psychotherapy with higher satisfaction and less opioid use. This research is young: encouraging, not settled.
Should you stop antidepressants or anxiety medication before surgery?
No, not on your own. Stopping these medications suddenly can cause withdrawal symptoms and a relapse at the exact moment you need to be steady.
A few medications may need an adjustment around surgery. That decision belongs to your surgeon, your anesthesia team, and your prescribing doctor, working together. Bring a full medication list to your pre-operative visit.
How Can You Prepare Your Mind Before Joint Replacement Surgery?
Prepare your mind the way you prepare your body: start a few weeks ahead, be honest with your care team, and build a plan. Here’s what I tell my patients.
- Tell your surgeon. Mention any history of depression, anxiety, or panic attacks. It will not count against you; it helps us plan.
- Keep your treatment going. Tell your therapist or primary care doctor your surgery date. Not sure where to start? The National Institute of Mental Health has clear, free information.
- Set honest expectations. Recovery is not a straight line. Weeks two and three are often harder on mood than week one.
- Line up your people. Pick a coach for the first two weeks, especially if you are going home the same day after outpatient joint replacement. Isolation feeds low mood.
- Protect your sleep. Keep a regular bedtime and ask us about pain control at night.
- Move every day. Walking is medicine for the joint and the brain.
- Learn what is normal. Read about the first week after joint replacement ahead of time.
What Feelings Are Normal After Surgery, and When Should You Call?
Some low mood, tearfulness, and frustration in the first few weeks is normal and usually passes as pain settles and sleep returns. Anesthesia, pain medication, poor sleep, and a sudden loss of independence all play a part.
Call your surgeon or primary care doctor if any of these last longer than two weeks or keep getting worse:
- Feeling sad, empty, or hopeless most of the day
- Losing interest in things you usually enjoy
- Skipping exercises or meals because you have no energy
- Constant worry or panic that something is wrong with the joint
If you ever have thoughts of harming yourself, call or text 988 (the 988 Suicide and Crisis Lifeline) right away, or go to the nearest emergency department. It is free, 24 hours a day.
I cover this stage in more detail in my article on depression after knee replacement surgery. The short version: tell us early. If you are concerned, I am concerned.
Where Can Middle Tennessee Patients Talk With a Surgeon About Mental Health and Joint Replacement?
Patients from Franklin, Nashville, Columbia, and across Middle Tennessee can have this conversation with me at the Bone and Joint Institute of Tennessee. I am a board-certified, fellowship-trained orthopaedic surgeon, and my practice is focused on hip replacement and knee replacement.
A consultation is a conversation, not a commitment to surgery. Bring your questions, your medication list, and your worries.
Bone and Joint Institute of Tennessee
3000 Edward Curd Lane, Franklin, TN 37067
(615) 791-2630
Schedule a consultation with Dr. Calendine online
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Medical disclaimer: This article is for education only and does not replace professional medical or mental health advice. Results vary from patient to patient. Talk with your orthopaedic surgeon and your mental health provider before making decisions about surgery or medication. In an emergency, call 911; in a mental health crisis, call or text 988.
References
- Smith AJ, Chang DAM, Neeman T, et al. Association between mental health conditions and revision rates in patients undergoing total hip and knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty. 2025;40:3015-3025. doi:10.1016/j.arth.2025.05.056
- Klement MR, Bala A, Blizzard DJ, et al. Should we think twice about psychiatric disease in total hip arthroplasty? J Arthroplasty. 2016;31(9 Suppl):221-226. doi:10.1016/j.arth.2016.01.063
- Rogers NB, Grits D, Emara AK, et al. Preoperative Veterans RAND-12 mental composite score of less than 40 leads to increased healthcare utilization and diminished improvement after primary knee arthroplasty. J Arthroplasty. 2022;37:2178-2185. doi:10.1016/j.arth.2022.05.033
- Gylvin SH, Jorgensen CC, Fink-Jensen A, Kehlet H. Psychiatric disease as a risk factor in fast-track hip and knee replacement. Acta Orthop. 2016;87(5):439-443. doi:10.3109/17453674.2016.1151292
- Duivenvoorden T, Vissers MM, Verhaar JAN, et al. Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study. Osteoarthritis Cartilage. 2013;21(12):1834-1840. doi:10.1016/j.joca.2013.08.022
- Jaiswal P, Railton P, Khong H, Smith C, Powell J. Impact of preoperative mental health status on functional outcome 1 year after total hip arthroplasty. Can J Surg. 2019;62(5):300-304. doi:10.1503/cjs.013718
