PERIOPERATIVE COMPLICATIONS OF THE PATIENTS WITH MENTAL DISORDERS UNDERGOING TOTAL HIP ARTHROPLASTY

Abstract

Aim: Mental disorder has been recognized as one of the troublesome factors in the perioperative management of the patients with total hip arthroplasty. However, precise clinical analysis regarding outcome of efficacy and complication in the surgery has not been reported in detail. Our institute has owed the treatment of the patients with various severe complications in the district of 1.2 million. The patients of hip disability with mental disorders have been introduced for the treatment and managed under co-operation with division of Psychiatry. This study focused on perioperative status and complications of the patients with mental disorders under went total hip arthroplasty.

Materials and methods: Retrospective survey included consecutive 354 THAs of the 309 patients performed from January 1986 to December 2006. Reason for the surgery was due to dysplastic osteoarthritis; 251 cases (85.1 %), rheumatoid arthritis; 45 (14.6 %), idiopathic osteonecrosis of femoral head; 12 (3.9 %) and post-traumatic arthritis 1 (0.3 %). The mean age was 61.0 (29–83) years. The rate and status of the patients with mental disorders, their perioperative complications and hospitalization period were analyzed, and compared with those of the patients without disorders.

Results: Fifteen patients with mental disorders (4.9 %) received THA and the mean age was 54.8 (34–76) years. Eleven patients (73.3 %) was due to dysplastic osteoarthritis, 3 (20.0 %) to osteonecrosis of the femoral head, and 1 (6.7 %) to rheumatoid arthritis. The disorder was categorized into mood disorder (7 cases), schizophrenia (6), somatoform disorder (1) and alcohol dependence (1). Pain relief was achieved and gait ability was improved in all the patients. Dislocation was found in 3 cases (20.0%), who were all dysplastic osteoarthritis, and which occurred after 8, 30, and 49 days, respectively. One patient had a possibility of implant malposition. Two-thirds was due to inactivity and/or impairments of attention influenced by the psychotic drugs, but not failed into recurrent type of dislocation. The rate was significantly higher than that of the patients without the disorders (2.3%), (p< 0.05). Infection, major bleeding, serious thrombo-embolitic events, and anesthetic complications were not found. Type of psychotropic drug was antideprssant (13 cases), antipsychotic (9), anticholinergic (5), antialcohl(3), antimanic(2) and antiepileptic (1). Their mean number of the drug type was 4.1 in the patients of mental disorders, 4.7 in the patients with dislocation and 3.9 without dislocation, which was significantly high in the patients with dislocation. P< 0.05. Hospitalization period of the patients was 37.2 (8–47) days, which was not significantly different from those of the patients without the disorders; 36.9 (10–94) days P=0.86.

Discussion: Postsurgical dislocation was evident finding in the series of the patients with mental disorders. Two thirds seemed to be affected by the medicated drugs, but not failed into recurrent type. Other major complication was not experienced and the treatment was successfully achieved under management under co-operation with division of Psychiatry and rehabilitation unit. THA for the patients with mental disorders contributed to recovery of hip disability.