title: Should We Think Twice About Psychiatric Disease in Total Hip Arthroplasty?
abstract: Psychiatric disease (PD) is common, and the effect on complications in total hip arthroplasty (THA) is poorly understood. The purpose of this study was to evaluate the medical and surgical postoperative complication profile in patients with PD, and we hypothesize that they will be significantly increased compared with control group.
  
  
  
  A search of the entire Medicare database from 2005 to 2011 was performed using International Classification of Disease version 9 codes to identify 86,976 patients who underwent primary THA with PD including bipolar (5626), depression (82,557), and schizophrenia (3776). A cohort of 590,689 served as a control with minimum 2-year follow-up. Medical and surgical complications at 30-day, 90-day, and overall time points were compared between the 2 cohorts.
  
  
  
  Patients with PD were more likely to be younger (age < 65 years; odds ratio [OR] = 4.51, P < .001), female (OR = 2.02, P < .001) and more medically complex (significant increase in 28/28 Elixhauser medical comorbidities, P < .001). There was a significant increase (P < .001) in 13/14 (92.8%) recorded postoperative medical complications rates at the 90-day time point. In addition, there was a statistically significant increase in periprosthetic infection (OR = 2.26, P < .001), periprosthetic fracture (OR = 2.09, P < .001), dislocation (OR = 2.30, P < .001), and THA revision (OR = 1.93, P < .001) at overall follow-up.
  
  
  
  Patients with PD who undergo elective primary THA have significantly increased medical and surgical complication rates in the global period and short-term follow-up, and these patients need to be counseled accordingly.
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Klement
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Abiram
authors.initials: A
authors.lastname: Bala
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blizzard
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wellman
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Bolognesi
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Thorsten M
authors.initials: TM
authors.lastname: Seyler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D015897:Comorbidity; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D057068:Periprosthetic Fractures / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: complications; depression; mental health disorder; psychiatric disease; total hip arthroplasty