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.
Division of Orthopaedics, Mary Imogene Basett Hospital, Cooperstown, NY. 13326.
M D
MD
Ries
D
D
Wolff
J A
JA
Shaul
D000203:Activities of Daily Living; D000368:Aged; D017281:Cost of Illness; D005260:Female; D006622:Hip Prosthesis / Q000191:economics / Q000523:psychology; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D016743:Mental Competency; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation