Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, District of Columbia.
Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, District of Columbia; Johns Hopkins Department of Orthopaedic Surgery, Columbia, Maryland.
J Arthroplasty. 2023 Jul;38(7):1349-1355.e1. doi: 10.1016/j.arth.2022.12.040. Epub 2022 Dec 28.
The relationship of chronic periprosthetic joint infection (PJI) treatment on the development and relapse of mood disorders remains largely unreported. This study aims to compare the incidence of different mental health disorders following antibiotic spacer placement for chronic PJI when compared to aseptic revisions and primary procedures.
Patients who underwent antibiotic spacer for septic total hip and knee arthroplasty (PJI THA/TKA) were identified in the PearlDiver Database using Current Procedure Terminology (CPT) codes for hip and knee antibiotic spacers. Patients who underwent aseptic revision and primary-THA/TKA were also identified using CPT codes. The incidences of depressive, anxiety, bipolar, psychotic, and stress disorders were identified within 2 years following the index procedures via Kaplan-Meier Analysis.
The risk of depressive (hazard ratio (HR): 1.5; P < .001) and stress (HR: 1.5; P < .001) disorders were significantly higher in those who underwent PJI-THA when compared to aseptic revision, with the added risk of bipolar when compared to primary THA. The risk of depressive (HR: 1.6; P < .001), stress (HR: 1.4; P < .001), bipolar (HR: 1.3; P < .001), and psychotic disorders (HR: 1.5; P = .003) were significantly higher in those who underwent PJI-TKA when compared to aseptic revision, with the added risk of anxiety when compared to primary TKA.
Patients who undergo spacer placement for septic-THA/TKA have a disproportionately higher incidence of mental health disorders within 2 years following surgery when compared those undergoing aseptic revisions and primary procedures. Due to this higher risk, physicians should strongly consider collaborative care with psychiatrists or mental health professionals.
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慢性假体周围关节感染（PJI）治疗与心境障碍的发展和复发之间的关系在很大程度上尚未得到报道。本研究旨在比较慢性 PJI 患者行抗生素 spacer 治疗与无菌翻修和初次手术相比，不同心理健康障碍的发生率。
使用 Current Procedure Terminology（CPT）髋关节和膝关节抗生素 spacer 的代码，在 PearlDiver 数据库中确定因感染性全髋关节和膝关节置换术（PJI-THA/TKA）而行抗生素 spacer 治疗的患者。使用 CPT 代码也确定了无菌翻修和初次-THA/TKA 的患者。通过 Kaplan-Meier 分析，在索引手术后 2 年内确定抑郁、焦虑、双相、精神病和应激障碍的发生率。
与无菌翻修相比，PJI-THA 患者发生抑郁（危险比（HR）：1.5；P <.001）和应激（HR：1.5；P <.001）障碍的风险显著更高，与初次 THA 相比，双相障碍的风险更高。与无菌翻修相比，PJI-TKA 患者发生抑郁（HR：1.6；P <.001）、应激（HR：1.4；P <.001）、双相（HR：1.3；P <.001）和精神病障碍（HR：1.5；P =.003）的风险显著更高，与初次 TKA 相比，焦虑障碍的风险更高。
与无菌翻修和初次手术相比，因感染性-THA/TKA 而行 spacer 治疗的患者在手术后 2 年内发生心理健康障碍的发生率显著更高。由于这种更高的风险，医生应强烈考虑与精神科医生或心理健康专业人员进行协作护理。
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