Psychiatric disease as a risk factor in fast-track hip and knee replacement

Abstract

Recent studies suggest that patients with psychiatric disorders tend to do worse than patients without a psychiatric diagnosis when undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Whether this is due to their psychiatric condition, pharmacological treatment, a combination of the two, or something else has not been thoroughly analyzed—and there are no internationally accepted guidelines for perioperative management of psychiatric patients. This overview summarizes our current knowledge on perioperative risks in patients with preoperative psychiatric disorders and the possible role of psychotropic drugs in the perioperative course. This will be useful when planning future strategies for improvement of surgical outcome following hip and knee arthroplasty.

Prospective psychometric characterization of hip and knee arthroplasty patients

“…However, an increased focus on preoperative risk-factors is required to define strategies for further reduction of postoperative morbidity (4,5,6). In this context, psychiatric conditions and/or psychopharmacological treatment has been demonstrated as important riskfactors for prolonged LOS, readmissions and morbidity in the fast-track THA and TKA setting (7,8,9). Although psychopathology and psychopharmacological medications may independently or collectively contribute to suboptimal outcome, unhealthy lifestyle choices, poor health care access or utilization (10) may also increase perioperative risk.…”

“…Although psychopathology and psychopharmacological medications may independently or collectively contribute to suboptimal outcome, unhealthy lifestyle choices, poor health care access or utilization (10) may also increase perioperative risk. However, psychiatric comorbidity is often neglected in the preoperative assessment (11) and no official guidelines exist on perioperative management of the psychiatric patients (8). In this overview Gylvin et al (8) have identified a dilemma between diagnosing patients with mental disorder according to ICD-10 (12) and assessing the current symptomatology by patient-reported outcome measures (PROMS).…”

More Severe Preoperative Kellgren–Lawrence Grades of Knee Osteoarthritis were Partially Associated with Better Postoperative Patient-Reported Outcomes in TKA Patients

“…A few variables are known to negatively influence postoperative patient satisfaction, including high severity and chronicity of pain, quadriceps strength, marked functional limitations, the presence of psychological disease and other co-morbid conditions, and poor coping strategies. [8][9][10] However, these measures are mostly subjective and difficult to obtain and interpret. Therefore, searching for objective measures that can be more easily interpreted may prove more helpful in preoperative decision-making.…”

Successful Treatment of Total Hip Arthroplasty to a Patient Associated with Alcoholic Cirrhosis and Severe Plated Deficiency with Preoperative Partial Splenic Embolization

“…Furthermore, psychiatric patient may have a potential risk of postoperative artificial joint dislocation [14]. Gylvin et al described that pre-existing psychological factors have an effect on the outcome of arthroplasty and appropriate strategies might be needed [15]. Tsukada et al reported the lower dislocation rate following THA via Direct Anterior Approach (DAA) than via posterior approach (PA).…”