Preparing for a knee or hip replacement is not only about scans, implants and physiotherapy. Your mental health can influence how you recover, how you experience pain, and whether you need another operation in the future. A recent study in the Journal of Arthroplasty, co-authored by Dr Jobe Shatrov, examined how depression and psychotic illness affect outcomes after hip and knee arthroplasty. The results highlight the value of whole-person care that supports both body and mind.

Read the full paper: https://www.arthroplastyjournal.org/article/S0883-5403(25)00574-1/fulltext

What the study investigated

The research team analysed outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA) and compared patients with and without diagnosed mental health conditions. The primary outcome was revision surgery, which is a follow-up operation required when an implant fails or complications occur. The researchers also considered other important clinical outcomes.

Two mental health groups were of interest:

• Patients with depression

• Patients with psychotic illness

The study found that depression was associated with a 32 percent higher relative risk of revision, while psychotic illness was associated with a 29 percent higher relative risk of revision. These findings suggest that mental health can influence the longer term success of joint replacement.

Why mental health can affect recovery

There are several reasons mental health can influence outcomes after arthroplasty:

• Pain perception can be heightened by anxiety and depression, which may increase pain scores and medication needs.

• Energy and motivation for rehabilitation can be lower, which may slow progress in the early weeks when movement and strength gains matter most.

• Sleep quality can be poorer, and sleep helps with tissue healing, mood regulation and pain control.

• Medical comorbidities and social factors sometimes cluster with mental illness, adding complexity to recovery plans.

None of these factors means that joint replacement will not work. It means that preparation, support and clear planning are even more important.

What this means for patients considering surgery

If you live with depression, anxiety, bipolar disorder or a psychotic illness, you can still do very well after joint replacement. The key is to prepare with the same care you would apply to physical prehabilitation.

Practical steps that help:

• Talk openly with your GP, psychiatrist or psychologist about your plans for surgery. Ask for their input on a pre-operative plan.

• Optimise medications well before surgery. Small adjustments can improve sleep and mood and reduce peri-operative stress.

• Start physiotherapy prehab to build strength and confidence. Even a few targeted sessions can improve early recovery.

• Create a simple post-operative routine. Arrange family or friend support, plan transport to physiotherapy, and set reminders for exercises and medications.

• Discuss pain expectations in advance. A clear plan for analgesia can prevent anxiety and reduce the risk of overuse of strong pain medicines.

How Dr Shatrov’s team supports a whole-person approach

Joint replacement is a team effort. Dr Shatrov’s approach combines evidence-based surgery with coordinated care:

• Clear pre-operative education so you know what to expect on the day and in the first six weeks

• Early mobilisation and structured physiotherapy protocols that are explained in plain language

• Communication with your GP and, where appropriate, your mental health clinicians to align goals and follow-up

• Regular checkpoints to monitor pain, function and mood, with early referral for extra support if needed

This simple framework helps reduce uncertainty and keeps you moving forward during the important early weeks of rehab.

Setting realistic timelines for recovery

Every patient starts from a different place. Typical recovery timeframes are:

• Return to most household activities within 2 to 3 weeks for many patients

• Return to office-based work between 3 and 6 weeks, depending on comfort and mobility

• Ongoing improvements in strength, balance and confidence over 3 to 6 months

• Continued gains for up to 12 months as swelling settles and strength builds

Your individual plan may differ based on age, baseline fitness, joint condition and support network. The goal is steady progress, not perfection on a fixed date.

Frequently asked questions

Will depression or another mental health condition stop me from having joint replacement?
No. Mental health conditions are common and manageable. The aim is to plan well and support you before and after surgery.

Does depression mean I will have more pain after surgery?
Not necessarily. Good pain planning, early movement, sleep support and reassurance go a long way. Many patients with depression do very well when pain expectations and rehab plans are clear.

Can I keep taking my mental health medications around the time of surgery?
In most cases yes, but this needs to be confirmed by your anaesthetist and prescribing doctor. Please bring a current medication list to every appointment.

What can I do now to improve my chances of a smooth recovery?
Start simple prehab exercises, improve sleep habits, cut down on alcohol, walk daily within comfort, and line up support at home for the first two weeks.

Key takeaways for patients and families

• Mental health matters in joint replacement. It can affect pain perception, energy for rehab and overall satisfaction.

• The study co-authored by Dr Shatrov found higher relative risks of revision in patients with depression and psychotic illness. Awareness helps us plan better.

• Preparation is powerful. A small amount of prehab, clear pain planning and coordinated support often make a large difference.

• You are not alone. Your surgical team, GP and mental health clinicians can work together to support a safe and confident recovery.

Read the full paper: https://www.arthroplastyjournal.org/article/S0883-5403(25)00574-1/fulltext

Learn more

• Total and partial knee replacement

• Robotic knee surgery

• Physiotherapy and post-operative rehabilitation

• About Dr Jobe Shatrov