Psychiatric disorders increase complication rate after primary total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Psychiatry
• Health Services Research

Background:

• Preoperative screening for psychiatric conditions in total knee arthroplasty (TKA) patients is challenging.
• Mental health disorders may be underdiagnosed in patients undergoing TKA.

Purpose of the Study:

• To evaluate the perioperative complication profile in patients with psychiatric disorders undergoing TKA.
• To compare complication rates between TKA patients with and without psychiatric disorders.

Main Methods:

• A retrospective analysis of the Medicare database (2005-2011) was conducted.
• Identified TKA patients with bipolar disorder, depression, or schizophrenia.
• Compared complication rates at 30-day, 90-day, and overall follow-up against a control group of 1,271,464 patients.

Main Results:

• Psychiatric patients were younger, more often female, and had higher medical comorbidity.
• A significant increase in 11/14 (78.5%) postoperative medical complications at 90 days was observed.
• Elevated rates of periprosthetic infection, fracture, revision TKA, and extensor mechanism rupture were found in psychiatric patients.

Conclusions:

• Patients with psychiatric disorders undergoing elective primary TKA experience significantly higher medical and surgical complication rates.
• Current screening tools for psychiatric disorders in TKA candidates are insufficient.
• Appropriate counseling regarding increased risks is essential for these patients before TKA.