Hip arthroplasty in mentally impaired patients

The outcome of elective hip arthroplasty in 11 mentally impaired patients was compared with a cohort of 244 mentally competent patients. The impaired patients had a diagnosis of cerebral palsy, schizophrenia, or Down's syndrome, and were unable to give their own surgical consent. Major complications requiring additional surgery occurred in 5 of the mentally impaired patients. Three patients sustained fractures of the femur below the stem and were treated with plating, 1 developed a deep infection requiring prosthesis removal, and 1 developed a thoracic decubiti with bone involvement requiring debridement and rotation flap coverage. Three of these patients also developed urinary tract infections. Of the other 6 mentally impaired patients, 3 developed urinary tract infections, and 1 had a deep venous thrombosis. Functional independence was improved after surgery in the mentally impaired patients. However, the average cost of hospitalization, length of stay, and complication rate were significantly higher (p < 0.05) than those of the mentally competent patients.