Infection and Mechanical Complications Are Risk Factors for New Diagnosis of a Mental Health Disorder After Total Joint Arthroplasty

Abstract

Background: Prior studies have demonstrated that depression is an independent risk factor for developing a prosthetic joint infection (PJI) after total joint arthroplasty (TJA). To our knowledge, there is no literature examining whether PJI or aseptic failure increases the risk of developing a new mental health diagnosis. Methods: PearlDiver Patient Database (Colorado Springs, CO) was used to identify 80,826 patients who underwent TJA without a pre-existing diagnosis of depression, anxiety, a stress and/or adjustment disorder, and/or current use of a selective serotonin reuptake inhibitor within the year prior to surgery. The odds of developing a new mental health issue or being prescribed a selective serotonin reuptake inhibitor within 1 year of an uncomplicated TJA was compared to those who developed PJI or mechanical failure within 90 days after TJA as well as to those who subsequently underwent revision surgery within 30 days of either complication using Fisher's exact test and Baptista-Pike. Results: A total of 6474 (8%) patients were diagnosed with a new mental health issue after TJA. PJI or mechanical failure led to significantly higher odds of new diagnoses with an odds ratio of 1.67 (95% confidence interval ¼ 1.26, 2.22) and 1.57 (1.24, 2.00), respectively. Undergoing revision surgery for PJI or mechanical failure increased the odds of developing a new mental health diagnosis to 2.10 (1.29, 3.42) and 2.24 (1.36, 3.72), respectively. There was no significant difference comparing those who developed PJI vs those who sustained mechanical complications. Conclusion: Patients who sustain complications after TJA are at increased odds of receiving a new mental health diagnosis, an effect further amplified if revision surgery is required.

The Effect of Spacer Treatment of Infected Hip and Knee Arthroplasties on Patients’ Mental Health: A Narrative Review of the Literature

“…In more detail, regarding the normative data of the populations examined in the analyzed papers [25][26][27][28][29][30][31][32], of the seven works that provided data on the pre-operative state, all reported a worse mental condition than the normal population [3,[11][12][13]15,18]. This condition is well known in the literature; several authors have, in fact, highlighted the higher rate of anxiety and depression in patients diagnosed with PJI, also analyzing how the same mental state is related to the greater risk of infection [15,17,[33][34][35][36][37]. From this point of view, our review suggests that although the mental state appears to be compromised in all the analyzed works, these conditions could be transitory with a certain improvement over time.…”

Utility of Diagnostic Tests Before Reimplantation in Patients Undergoing 2-Stage Revision Total Joint Arthroplasty

“…While validated diagnostic criteria using serum and synovial biomarkers have been developed by the Musculoskeletal Infection Society and the International Consensus Group to diagnose PJI 10-12 , no validated guidelines exist to help guide the timing of the second stage in patients being treated with 2-stage revision. This is largely because of poor diagnostic accuracy of biomarkers for predicting persistent infection during the second stage of 2-stage revision or recurrent infection after 2-stage revision 4,5 . However, this topic is constantly evolving, necessitating re-evaluation of the utility of various biomarkers for identifying persistent or recurrent infection after 2-stage revision.…”

“…The US national economic burden of PJI management is projected to exceed $1.85 billion by 2030 1 . In addition, PJI is associated with functional disability, mental health disorders, and alarmingly high rates of mortality in affected patients 2-5 . Although 2-stage revision for PJI is usually successful, 12% to 28% of patients experience treatment failure after the second stage of 2-stage revision 2,6-9 .…”