Prospective psychometric characterization of hip and knee arthroplasty patients.

BACKGROUND: Psychiatric conditions and psychopharmacological treatments have been demonstrated to be important risk-factors for prolonged hospital length of stay, readmission and morbidity, following fast-track total hip (THA) and total knee arthroplasty (TKA). AIMS: The aim of the study was to provide a detailed description of the preoperative psychiatric characteristics of a well-defined patient population undergoing THA and TKA, using the 90-item Symptom Checklist (SCL-90-R). METHODS: A pre-surgical population of 2183 patients completed the full SCL-90-R prior to THA/TKA from 2015 to 2016. The SCL-90-R scale and total scores of the pre-surgical sample were compared to the scores of an age- and gender stratified Danish sample of healthy controls. A Mokken scalogram analysis was conducted to assess the scalability of the SCL-90-R in both samples. RESULTS: The Mokken analysis yielded acceptable scalability coefficients above 0.30 in all subscales of the SCL-90-R except psycoticism (0.28). There was no clinically significant difference (effect size = <0.50) in the SCL-90-R total score between the pre-surgical and the healthy controls samples, although pre-surgical patients had lower mean scores compared to the healthy controls in all subscales except somatization (effect size = -0.22). CONCLUSION: The Mokken analysis demonstrated that the SCL-90-R and its subscales express valid measures of psychopathology in our surgical sample. The psychiatric profile of the pre-surgical patient sample indicates that patients undergoing THA/TKA are not more burdened by psychiatric symptoms than a healthy control group with the exception of symptoms relating to somatization.

Psychopharmacologic treatment and blood transfusion in fast-track total hip and knee arthroplasty.

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) and other psychotropics are receiving increasing attention due to reports on inhibition of thrombocyte function and an increased bleeding risk in surgical settings. Studies in total hip and total knee arthroplasty (THA and TKA, respectively) have shown conflicting results, questioning whether the potential increased bleeding risk is of clinical importance. STUDY DESIGN AND METHODS: Prospective consecutive collection of data on preoperative comorbidity in patients undergoing primary unilateral THA or TKA was cross-referenced with regional transfusion databases and The Danish National Database of Reimbursed Prescriptions for information regarding blood transfusions and psychopharmacologic treatment. All participating orthopedic centers followed similar perioperative guidelines. Multiple logistic regression analysis was applied to calculate odds ratios (ORs) for transfusion between preoperative users and nonusers of psychotropics. RESULTS: Of 8402 patients, 569 (6.8%) were SSRI users versus 7833 (93.2%) nonusers. A total of 109 (19,2%) patients in the SSRI group and 700 (8.9%) in the "no-SSRI" group received blood intra- or postoperatively. Preoperative SSRI treatment was a risk factor for perioperative transfusion (OR, 1.98; 95% confidence interval [CI], 1.44-2.70). Other antidepressants (OAs) were associated with an increased risk of transfusion (OR, 1.69; 95% CI, 1.17-2.44) as well as the combination of SSRIs and OAs (OR, 3.31; 95% CI, 1.79-6.13). Singular use of antipsychotics (APs) increased the transfusion risk (OR, 2.37; 95% CI, 1.04-2.41), while AP medicine in combination with antidepressants did not. CONCLUSIONS: Preoperative treatment with SSRIs, OAs, or APs are independent risk factors for blood transfusion in elective fast-track THA and TKA.

Psychiatric disease as a risk factor in fast-track hip and knee replacement.

Recent studies suggest that patients with psychiatric disorders tend to do worse than patients without a psychiatric diagnosis when undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Whether this is due to their psychiatric condition, pharmacological treatment, a combination of the two, or something else has not been thoroughly analyzed-and there are no internationally accepted guidelines for perioperative management of psychiatric patients. This overview summarizes our current knowledge on perioperative risks in patients with preoperative psychiatric disorders and the possible role of psychotropic drugs in the perioperative course. This will be useful when planning future strategies for improvement of surgical outcome following hip and knee arthroplasty.