Long-term Cognitive Trajectory After Total Joint Arthroplasty

Abstract

ImportanceIndividuals with total joint arthroplasty (TJA) have long-term exposure to metal-containing implants; however, whether long-term exposure to artificial implants is associated with cognitive function is unknown.ObjectiveTo compare long-term cognitive trajectories in individuals with and without TJA.Design, Setting, and ParticipantsThis population-based cohort study assessed serial cognitive evaluations of 5550 participants (≥50 years of age) from the Mayo Clinic Study of Aging between November 1, 2004, and December 31, 2020.ExposuresTotal joint arthroplasty of the hip or the knee.Main Outcomes and MeasuresLinear mixed-effects models were used to compare the annualized rate of change in global and domain-specific cognitive scores in participants with and without TJA, adjusting for age, sex, educational level, apolipoprotein E ε4 carrier status, and cognitive test practice effects.ResultsA total of 5550 participants (mean [SD] age at baseline, 73.04 [10.02] years; 2830 [51.0%] male) were evaluated. A total of 952 participants had undergone at least 1 TJA of the hip (THA, n = 430) or the knee (TKA, n = 626) before or after entry into the cohort. Participants with TJA were older, more likely to be female, and had a higher body mass index than participants without TJA. No difference was observed in the rate of cognitive decline in participants with and without TJA until 80 years of age. A slightly faster cognitive decline at 80 years or older and more than 8 years from surgery was observed (b = −0.03; 95% CI, −0.04 to −0.02). In stratified analyses by surgery type, the faster decline was observed primarily among older participants with TKA (b = −0.04; 95% CI, −0.06 to −0.02).Conclusions and RelevanceIn this cohort study, long-term cognitive trajectories in individuals with and without TJA were largely similar except for a slightly faster decline among the oldest patients with TKA; however, the magnitude of difference was small and of unknown clinical significance.

Postoperative cognitive dysfunction: a concept analysis

“… Preexisting cognitive impairment (Non-modifiable) - The presence of a cognitive disorder before surgery increases the risk of POCD [ 51 , 52 , 53 ]. Surgical types and techniques (Modifiable) - POCD occurs after major surgeries such as open-heart surgery [ 53 , 54 ], total hip replacement [ 55 , 56 ], carotid surgery [ 57 – 59 ], and thoracic surgery [ 60 , 61 ]. - In cardiac surgery, off-pump coronary artery bypass grafting (OPAC) is associated with a reduced risk of POCD and is linked to cognitive improvement after cardiac surgery [ 62 ].…”

“…- POCD occurs after major surgeries such as open-heart surgery [ 53 , 54 ], total hip replacement [ 55 , 56 ], carotid surgery [ 57 – 59 ], and thoracic surgery [ 60 , 61 ].…”

Mayo‐PACC: A parsimonious preclinical Alzheimer's disease cognitive composite comprised of public‐domain measures to facilitate clinical translation

“…All models were adjusted for age at current visit, age 2 at current visit, education level (in years), practice effects, and sex. Previous studies have shown there is typically a substantial practice effect from the first to second visit as well as smaller practice effects after the second visit 36–39 . Therefore, we account for practice effects by a term for difference between visit 1 and subsequent visits (not visit 1 vs. visit 1) as well as terms for time (years) since visit 1 and time (years) since visit 1 squared 39 .…”

“…Psychometric properties: Psychometric properties of component measures and composites were examined descriptively shown there is typically a substantial practice effect from the first to second visit as well as smaller practice effects after the second visit [36][37][38][39] . Therefore, we account for practice effects by a term for difference between visit 1 and subsequent visits (not visit 1 vs. visit 1) as well as terms for time (years) since visit 1 and time (years) since visit 1 squared 39 . Between subject variability was accounted for by ran-…”

Hip & Pelvis

“…These authors, based in Rochester (Minnesota, USA) , set out to establish what happens to a patient’s cognitive ability following total joint arthroplasty (TJA). 3 They attempted to answer the question by assessing serial cognitive evaluations of 5,550 participants (aged 50 years and older) from the Mayo Clinic Study of Aging, to assess the effect of TJA on cognitive trajectory in patients following surgery. The authors found no difference in the observed rate of cognitive decline in those with or without TJA until age 80 years, after which there was a slightly faster cognitive decline that was also found in those more than eight years from surgery.…”