Hlavinka William J, Abdullah Mohammed S, Sontam Tarun R, Chavda Hetsinhji, Alqazzaz Aymen, Sheth Neil P
Texas A&M School of Medicine, Baylor University Medical Center, Department of Medical Education, Dallas, Texas.
Department of Orthopedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
J Arthroplasty. 2025 Jun;40(6):1567-1572.e1. doi: 10.1016/j.arth.2024.11.055. Epub 2024 Nov 29.
There is a scarcity of literature concerning individuals who have existing post-traumatic stress disorder (PTSD) and their outcomes after primary total knee arthroplasty (TKA). This study compared outcomes in patients undergoing primary TKA who have a previous history of PTSD.
An electronic health care database was used to identify patients diagnosed with PTSD undergoing TKA. Through 1:1 ratio propensity matching, these patients were matched with a cohort of non-PTSD (NPTSD) individuals. Postoperative parameters, including health care visits and prescriptions, were assessed within a 1-month time frame following surgery. Complications and revision rates were evaluated after one month, 6 months, one year, 2 years, and 5 years. A total of 646,186 patients undergoing primary TKA were identified. Ultimately, 7,381 patients who had PTSD were propensity matched to 7,381 NPTSD patients.
Patients who had PTSD presented to the emergency department at a higher rate than NPTSD patients within 7 days (OR [odds ratio]: 1.5; CI [confidence interval]: 1.0 to 2.4) postoperative. Within one month, cohorts were prescribed opioid analgesics at similar rates (OR: 0.9; CI: 0.8 to 1.1). Patients who had PTSD were found to have a higher number of infections within one month (OR: 1.7; CI: 1.2 to 2.6) and 5 years (OR: 1.2; CI: 1.0 to 1.5), periprosthetic fractures at 6 months (OR: 2.1; CI: 1.0 to 4.5) and one year (OR: 2.1; CI: 1. to 4.0), and higher revision rates at all time points.
Patients diagnosed with PTSD exhibited higher rates of periprosthetic infections at one month and 5 years and increased periprosthetic fracture rates at 6 months and one year after TKA compared to NPTSD patients. These findings underscore the importance of tailored early postoperative education and understanding outcomes for patients who have PTSD in contrast to those who do not have a diagnosis of PTSD.
关于患有创伤后应激障碍（PTSD）的个体及其初次全膝关节置换术（TKA）后的结果，相关文献较少。本研究比较了有PTSD病史的初次TKA患者的手术结果。
使用电子医疗数据库识别接受TKA的PTSD诊断患者。通过1:1比例的倾向匹配，将这些患者与一组非PTSD（NPTSD）个体进行匹配。术后参数，包括医疗就诊和处方，在术后1个月的时间范围内进行评估。在1个月、6个月、1年、2年和5年后评估并发症和翻修率。共识别出646,186例接受初次TKA的患者。最终，7381例患有PTSD的患者与7381例NPTSD患者进行了倾向匹配。
PTSD患者术后7天内到急诊科就诊的比例高于NPTSD患者（比值比[OR]：1.5；置信区间[CI]：1.0至2.4）。在1个月内，两组患者使用阿片类镇痛药的比例相似（OR：0.9；CI：0.8至1.1）。发现PTSD患者在1个月（OR：1.7；CI：1.2至2.6）和5年（OR：1.2；CI：1.0至1.5）内感染次数更多，在6个月（OR：2.1；CI：1.0至4.5）和1年（OR：2.1；CI：1.0至4.0）时发生假体周围骨折，并且在所有时间点的翻修率更高。
与NPTSD患者相比，诊断为PTSD的患者在TKA术后1个月和5年时假体周围感染率更高，在6个月和1年时假体周围骨折率增加。这些发现强调了为患有PTSD的患者提供量身定制的早期术后教育以及了解其手术结果的重要性，这与未诊断为PTSD的患者形成对比。
