Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky.
UofL Health, ULP Orthopedics, Louisville, Kentucky.
J Arthroplasty. 2024 Aug;39(8S1):S161-S166.e1. doi: 10.1016/j.arth.2024.02.037. Epub 2024 Feb 23.
Psychotropic medications are commonly used to treat several mental health conditions. The aim of this study was to determine the impact of psychotropic medications in patients undergoing primary total knee arthroplasty (TKA) with respect to postoperative opioid use, complications, patient-reported outcome measures, and satisfaction.
This is a retrospective cohort study of 514 consecutive patients undergoing primary TKA. There were 120 patients (23.3%) who were excluded due to preoperative opioid usage. The remaining 394 patients had a minimum 1-year follow-up. Of those, 133 (34%) were on psychotropic medications preoperatively and were compared to the remaining 261 (66%) patients who were not on psychotropics. Clinical data, satisfaction, Knee Society (KS) scores, Western Ontario McMaster Universities Arthritis Index, Patient-Reported Outcomes Measurement Index Score, Forgotten Joint Scores, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, postoperative opioid medication usage, and complications were compared.
The study cohort (psychotropic medications) had significantly lower postoperative KS Function, KS Knee, Forgotten Joint Scores, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Western Ontario McMaster Universities Arthritis Index, and Patient-Reported Outcomes Measurement Index Score compared to the control group. The study group had a lower overall satisfaction score (Likert scale 1 to 5) and a lower percentage of patients either satisfied or very satisfied (4.55 versus 4.79, P < .001; 92.0 versus 97.24%, P = .03, respectively). Postoperative opioid usage was significantly greater in the study group at both 6.4 weeks (range, 4 to 8) and 12-month follow-up (52.76 versus 13.33%, P < .001; 5.51 versus 0.39%, P = .002, respectively). There were no differences in complications and revisions between the groups.
Patients on psychotropic medications should be educated on the risk of increased opioid consumption, diminished satisfaction, and patient-reported outcome measures following primary TKA. Given the large number of patients on psychotropic medications undergoing TKA, additional studies are needed to further improve clinical outcomes in this group.
精神药物常用于治疗多种心理健康状况。本研究的目的是确定精神药物对接受初次全膝关节置换术（TKA）患者的影响，包括术后阿片类药物使用、并发症、患者报告的结果测量和满意度。
这是一项对 514 例连续接受初次 TKA 的患者进行的回顾性队列研究。由于术前使用阿片类药物，120 例患者（23.3%）被排除在外。其余 394 例患者有至少 1 年的随访。其中，133 例（34%）患者术前使用精神药物，并与其余 261 例（66%）未使用精神药物的患者进行比较。比较了临床数据、满意度、膝关节协会（KS）评分、西安大略和麦克马斯特大学骨关节炎指数、患者报告的结果测量指数评分、遗忘关节评分、膝关节损伤和骨关节炎关节置换评分、术后阿片类药物使用和并发症。
研究队列（使用精神药物）的术后 KS 功能、KS 膝关节、遗忘关节评分、膝关节损伤和骨关节炎关节置换评分、西安大略和麦克马斯特大学骨关节炎指数以及患者报告的结果测量指数评分明显低于对照组。研究组的总体满意度评分（1 到 5 的李克特量表）较低，且满意度或非常满意度的患者比例也较低（4.55 比 4.79，P <.001；92.0 比 97.24%，P <.03）。研究组在术后 6.4 周（范围为 4 至 8 周）和 12 个月随访时（52.76 比 13.33%，P <.001；5.51 比 0.39%，P <.002）的阿片类药物使用率明显更高。两组之间的并发症和翻修无差异。
应向接受初次 TKA 的使用精神药物的患者进行教育，告知他们在使用阿片类药物、降低满意度和患者报告的结果测量方面的风险。鉴于大量接受 TKA 的精神药物患者，需要进一步开展研究以改善该人群的临床结果。
