Psychiatric disorders increase complication rate after primary total knee arthroplasty.
BACKGROUND
Psychiatric disease is difficult to screen preoperatively and the incidence of mental health disorders in patients undergoing total knee arthroplasty (TKA) may be underappreciated. The purpose of this study is to evaluate the perioperative complication profile in patients with psychiatric disorders.


METHODS
A search of the entire Medicare database from 2005 to 2011 was performed to identify patients who underwent primary TKA with bipolar disorder (20,972), depression (187,448), and schizophrenia (7607). A cohort of 1,271,464 patients as controls with minimum 2.5-year follow-up. Medial and surgical complications at 30-days, 90-days, and overall were compared between the two cohorts.


RESULTS
Patients with any psychiatric disease were more likely to be younger (age<65 OR 5.5, p<0.001), female (OR 2.61, p<0.001), and more medically complex (significant increase in 28/28 Elixhauser medical comorbidities, p<0.05). There was a significant increase (p<0.001) in 11/14 (78.5%) of recorded postoperative medical complication rates at 90-days. There was a statistically significant increase in periprosthetic infection (OR 2.17 p<0.001), periprosthetic fracture (OR 2.40, p<0.001), revision TKA (OR 2.06, p<0.001), and extensor mechanism rupture (OR 2.41, p<0.001) at 90day and overall time points.


CONCLUSIONS
Patients with psychiatric disorders who undergo elective primary TKA have significantly increased medical and surgical complication rates in the global period and short term follow-up. An ideal screening tool is yet to be determined and these patients need to be counseled appropriately regarding the increased complication rates before proceeding with TKA.
Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States. Electronic address: Mitchell.klement@dm.duke.edu.
Mitchell R
MR
Klement
Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States.
Brian T
BT
Nickel
Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States.
Colin T
CT
Penrose
Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States.
Abiram
A
Bala
Department of Biostatistics and Bioinformatics, Duke University, 7062 North Pavilion, DCRI, Durham, NC 27705, United States.
Cynthia L
CL
Green
Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States.
Samuel S
SS
Wellman
Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States.
Michael P
MP
Bolognesi
Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States.
Thorsten M
TM
Seyler
D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000706:statistics & numerical data*; D015897:Comorbidity; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000453:epidemiology* / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
Complications; Depression; Mental health; Psychiatric disease; Psychiatric disorders; Total knee arthroplasty