Patients with schizophrenia, bipolar disorder at greater risk of complications after TJA: 5 things to know

Written by Shayna Korol | January 26, 2018 | Print  |

According to a study in The Journal of Arthroplasty, patients with bipolar disorder or schizophrenia are at a heightened risk of increased complications after total joint arthroplasty.

Here is what you need to know:


1. The study authors performed a retrospective review of 156 TJAs — 125 primaries and 31 revisions — at a single institution from 2000 to 2015.


2. Bipolar and schizophrenic patients were identified based on International Classification of Diseases, Ninth Revision codes or by those actively taking antipsychotic medications. The authors then performed manual chart review to confirm diagnoses. The psychosis patient cohort was matched 3:1 for a variety of factors. Revisions and readmissions were evaluated.


3. Patients with schizophrenia or bipolar disorder were more likely to develop periprosthetic joint infection at 90 days, two years and at any point in time than patients without schizophrenia or bipolar disorder.


4. Psychosis patients had increased odds of aseptic and mechanical revisions, particularly from dislocation, at all endpoints. Patients with psychosis had a higher number of postoperative ER visits and were more likely to be discharged to a rehabilitation facility than patients without psychosis.


5. The authors suggest patients with schizophrenia or bipolar disorder may have several barriers to self-care after TJA. Increased preoperative education and screening of this patient population may be necessary before TJA.


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