Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
J Arthroplasty. 2018 May;33(5):1462-1466. doi: 10.1016/j.arth.2017.12.006. Epub 2017 Dec 14.
Although it has been shown that anxiety and depression are associated with increased complications after total joint arthroplasty (TJA), the outcomes of TJA in patients with a history of psychosis are unknown. This study evaluated the influence of bipolar and schizophrenic disorders on complications after TJA, particularly aseptic and septic revisions.
A retrospective review of 156 TJAs (125 primaries and 31 revisions) was performed at a single institution from 2000 to 2015. Bipolar and schizophrenic patients were identified based on International Classification of Diseases, Ninth Revision codes or by those actively taking anti-psychotic medications, followed by manual chart review to confirm diagnoses. The psychosis patient cohort was matched 3:1 for a variety of factors. Revisions and readmissions were evaluated. Survivorship curves were generated.
Patients with schizophrenia or bipolar disorder had an increased odds of developing peri-prosthetic joint infection at 90 days (odds ratio [OR] 3.34, P = .049), 2 years (OR 3.94, P = .004), and at any time point (OR 4.32, P = .002). Psychosis patients had increased odds of aseptic and mechanical revisions at all endpoints, particularly from dislocation. Psychosis patients had a higher number of post-operative emergency department visits (P < .001), and were more likely to be discharged to a rehabilitation facility (P < .001).
Patients with bipolar affective disorder or schizophrenia may have multiple barriers to self-care after TJA, and are at an increased risk for undergoing revision TJA for prosthetic joint infection and mechanical causes. Increased pre-operative education and screening of this patient population may be necessary prior to performing TJA.
尽管已经表明焦虑和抑郁与全关节置换术后（TJA）并发症的增加有关，但患有精神病病史的 TJA 患者的结果尚不清楚。本研究评估了双相和精神分裂症对 TJA 后并发症的影响，特别是无菌性和感染性翻修。
对 2000 年至 2015 年在一家机构进行的 156 例 TJA（125 例初次手术和 31 例翻修手术）进行回顾性研究。根据国际疾病分类，第九版代码或正在服用抗精神病药物的患者确定双相和精神分裂症患者，然后通过手动图表审查来确认诊断。精神病患者队列按多种因素进行 3:1 匹配。评估了翻修和再入院情况。生成了生存曲线。
患有精神分裂症或双相情感障碍的患者在 90 天（优势比 [OR] 3.34，P =.049），2 年（OR 3.94，P =.004）和任何时间点（OR 4.32，P =.002）发生假体周围关节感染的可能性增加。精神病患者在所有终点发生无菌性和机械性翻修的可能性增加，尤其是脱位。精神病患者术后急诊就诊次数较多（P <.001），更有可能被送往康复设施（P <.001）。
双相情感障碍或精神分裂症患者在 TJA 后可能存在多种自我护理障碍，并且由于假体关节感染和机械原因而进行 TJA 翻修的风险增加。在进行 TJA 之前，可能需要对该患者群体进行更多的术前教育和筛选。
