The prevalence of cognitive dysfunction after conventional and computer-assisted total knee replacement

Post operative cognitive dysfunction (POCD) is common following lower limb arthroplasty. The prevalence varies from 41-75% at 7 days to 18-45% at 3 months post operatively. The wide range of prevalence is due to inconsistencies in defining and quantifying POCD. The aim of this study is to ascertain an accurate prevalence of POCD in patients who had either conventional TKR (n=31) or computer-assisted TKR (n=30). Cognition was assessed pre-operatively, 6 days and at 6 months post-operatively by a battery of 11 validated neuropsychological tests. We found the mean prevalence of POCD to be 72% at 6 days and 30% at 6 months post-operatively. When comparing the prevalence of POCD between the two groups, we found no statistically significant difference at 6 days or at 6 months post-operatively. The only statistically significant factor between the two groups was the mean procedure time which was longer in the computer-assisted TKR group (p=< 0.001). We found a correlation between procedure time and the prevalence of POCD at 6 days (p=0.02) but not 6 months (p=0.26). POCD occurs in approximately one-third of TKR patients at 6 months post-operatively. The cause is undoubtedly multi-factorial; however we have demonstrated that procedure time may be a contributing factor. Our results suggest that using an intra-medullary femoral jig has no effect on POCD. Further research into the cognitive effects following TKR with and without a tourniquet would be of benefit.