Postoperative Cognitive Dysfunction in Indian Patients Undergoing Total Knee Replacement Under Spinal Anesthesia

Area of Science:

• Orthopedic Surgery
• Geriatric Medicine
• Neuroscience

Background:

• Total knee replacement (TKR) is increasingly common in the elderly due to longer life expectancy and improved surgical outcomes.
• Postoperative cognitive dysfunction (POCD) is a recognized complication, but research has primarily focused on non-orthopedic surgeries.
• Limited data exists on POCD incidence and predictors in the elderly Indian population undergoing TKR.

Purpose of the Study:

• To investigate the incidence of POCD in elderly Indian patients undergoing TKR under spinal anesthesia.
• To identify potential predictive factors associated with the development of POCD in this demographic.

Main Methods:

• A prospective, observational study was conducted on patients over 60 years old undergoing TKR.
• Preoperative and serial postoperative cognitive assessments (MMSE) were performed, along with recording of laboratory values and oxygen saturation.
• Statistical analysis identified significant differences in factors associated with POCD.

Main Results:

• The incidence of POCD was observed in 63 out of 600 patients on the second postoperative day.
• While some patients recovered, 20 individuals experienced persistent cognitive dysfunction at one year.
• Electrolyte imbalance, age over 80, and low oxygen saturation were statistically significant predictors of POCD.

Conclusions:

• POCD is a distinct clinical entity following TKR in the elderly Indian population, leading to both short- and long-term cognitive deficits.
• Electrolyte imbalance, advanced age, and compromised oxygen saturation are significant risk factors for developing POCD post-TKR.