Download PDF
The Journal of Hip Surgery 2020; 04(02): 077-083
DOI: 10.1055/s-0040-1712522
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Call to Action: A High Prevalence of Mental Health Conditions in Septic Compared with Aseptic Revision Total Hip Arthroplasty

Jared Warren
1   Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Hiba K. Anis
1   Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Alison K. Klika
1   Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Suparna Navale
2   Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
,
Guangjin Zhou
2   Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
,
Wael Barsoum
3   Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, Florida
,
Carlos A. Higuera
3   Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, Florida
,
Nicolas S. Piuzzi
1   Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations Funding There was no funding for this study.
Further Information

Publication History

21 January 2020

14 April 2020

Publication Date:
11 June 2020 (online)

    Permissions and Reprints

Abstract

Prosthetic joint infections (PJIs) after primary total hip arthroplasty (pTHA) are known to have a profound impact on patients' pain and function. However, there is little evidence on the association between PJIs and mental health in pTHA and revision total hip arthroplasty (rTHA) patients. The purpose of this study was to compare the prevalence of mental health conditions among patients undergoing (1) pTHA, (2) septic rTHA, and (3) aseptic rTHA. All THAs performed between 2005 and 2014 were queried using the Healthcare Cost and Utilization Project State Inpatient Databases. This yielded 468,663 patients. Patients were separated into the following cohorts based on procedure: primary, septic revision, and aseptic revision. Diagnoses of any mental health condition as well as the following specific conditions were compared among the three cohorts: schizophrenia/delusion, bipolar disorder, depression/mood disorder, personality disorder, anxiety/somatic/dissociative disorder, eating disorders, attention-deficit/hyperactivity disorder/conduct/impulse control, alcohol abuse, and drug abuse. Univariate analysis was performed to assess differences and trends in mental health conditions among the three cohorts. The prevalence of mental health conditions overall in rTHA patients increased throughout the study period. There was a significantly higher prevalence of mental health conditions overall among patients in the septic rTHA cohort (n = 1,818, 28.0%) compared with the pTHA (n = 81,616, 19.2%; p < 0.001), and aseptic rTHA (n = 7,594, 20.9%; p < 0.001) cohorts. Specifically, septic rTHA patients had a higher prevalence of schizophrenia (p < 0.001; p < 0.001), bipolar disorder (p < 0.001; p < 0.001), depression (p < 0.001; p < 0.001), personality disorders (p = 0.0015; p = 0.013), anxiety (p < 0.001; p = 0.0055), eating disorders (p < 0.001; p = 0.006), alcohol abuse (p < 0.001; p < 0.001), and drug abuse (p < 0.001; p < 0.001) compared with primary THA and aseptic rTHA, respectively. Overall, rates of mental health conditions were significantly higher among septic rTHA patients. Alcohol and drug abuse were approximately twice as prevalent among patients undergoing rTHA for infection compared with primary or aseptic rTHA patients. The level of evidence of the study is level III.

Keywords

mental health - THA - PJI - aseptic revision - septic revision

Note

This was exempt from IRB review as it was performed with a deidentified database. This work was undertaken at Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, United states.


 

  • References

  • 1 Schaefer JD, Caspi A, Belsky DW. , et al. Enduring mental health: prevalence and prediction. J Abnorm Psychol 2017; 126 (02) 212-224
    CrossrefPubMedGoogle Scholar
  • 2 Kessler RC, McGonagle KA, Zhao S. , et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51 (01) 8-19
    CrossrefPubMedGoogle Scholar
  • 3 Andrade L, Walters EE, Gentil V, Laurenti R. Prevalence of ICD-10 mental disorders in a catchment area in the city of São Paulo, Brazil. Soc Psychiatry Psychiatr Epidemiol 2002; 37 (07) 316-325
    CrossrefPubMedGoogle Scholar
  • 4 Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62 (06) 593-602
    CrossrefPubMedGoogle Scholar
  • 5 Harvard Medical School. 12-month prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. Available at: https://www.hcp.med.harvard.edu/ncs/ftpdir/table_ncsr_12monthprevgenderxage.pdf . Accessed May 18, 2019
    PubMed
  • 6 Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis 2006; 3 (02) A42
    PubMedGoogle Scholar
  • 7 Henderson DC, Vincenzi B, Andrea NV, Ulloa M, Copeland PM. Pathophysiological mechanisms of increased cardiometabolic risk in people with schizophrenia and other severe mental illnesses. Lancet Psychiatry 2015; 2 (05) 452-464
    CrossrefPubMedGoogle Scholar
  • 8 Jeste DV, Gladsjo JA, Lindamer LA, Lacro JP. Medical comorbidity in schizophrenia. Schizophr Bull 1996; 22 (03) 413-430
    CrossrefPubMedGoogle Scholar
  • 9 Baxter AJ, Charlson FJ, Somerville AJ, Whiteford HA. Mental disorders as risk factors: assessing the evidence for the Global Burden of Disease Study. BMC Med 2011; 9 (134) 134
    CrossrefPubMedGoogle Scholar
  • 10 Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA 2007; 298 (14) 1685-1687
    CrossrefPubMedGoogle Scholar
  • 11 Bennett S, Thomas AJ. Depression and dementia: cause, consequence or coincidence?. Maturitas 2014; 79 (02) 184-190
    CrossrefPubMedGoogle Scholar
  • 12 Trautmann S, Rehm J, Wittchen HU. The economic costs of mental disorders: do our societies react appropriately to the burden of mental disorders?. EMBO Rep 2016; 17 (09) 1245-1249
    PubMedGoogle Scholar
  • 13 Klement MR, Bala A, Blizzard DJ, Wellman SS, Bolognesi MP, Seyler TM. Should we think twice about psychiatric disease in total hip arthroplasty?. J Arthroplasty 2016; 31 (Suppl. 09) 221-226
    CrossrefPubMedGoogle Scholar
  • 14 Halawi MJ, Chiu D, Gronbeck C, Savoy L, Williams VJ, Cote MP. Psychological distress independently predicts prolonged hospitalization after primary total hip and knee arthroplasty. J Arthroplasty 2019; 34 (08) 1598-1601
    CrossrefPubMedGoogle Scholar
  • 15 Ellis HB, Howard KJ, Khaleel MA, Bucholz R. Effect of psychopathology on patient-perceived indigent population. J Bone Joint Surg Am 2012; 84 (01) 1-8
    PubMedGoogle Scholar
  • 16 Howard KJ, Ellis HB, Khaleel MA, Gatchel RJ, Bucholz R. Psychosocial profiles of indigent patients with severe osteoarthritis requiring arthroplasty. J Arthroplasty 2011; 26 (02) 244-249
    CrossrefPubMedGoogle Scholar
  • 17 Gylvin SH, Jørgensen CC, Fink-Jensen A, Gislason GH, Kehlet H. ; Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group. The role of psychiatric diagnoses for outcome after hip and knee arthroplasty. J Arthroplasty 2017; 32 (12) 3611-3615
    CrossrefPubMedGoogle Scholar
  • 18 Vissers MM, Bussmann JB, Verhaar JAN, Busschbach JJV, Bierma-Zeinstra SMA, Reijman M. Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review. Semin Arthritis Rheum 2012; 41 (04) 576-588
    CrossrefPubMedGoogle Scholar
  • 19 Kurtz SM, Lau EC, Son MS, Chang ET, Zimmerli W, Parvizi J. Are we winning or losing the battle with periprosthetic joint infection: trends in periprosthetic joint infection and mortality risk for the medicare population. J Arthroplasty 2018; 33 (10) 3238-3245
    CrossrefPubMedGoogle Scholar
  • 20 Springer BD. Periprosthetic joint infection. Paper presented at: AAHKS Spring Meeting Symposium; 2016; Washington, DC
    PubMedGoogle Scholar
  • 21 Boddapati V, Fu MC, Tetreault MW, Blevins JL, Richardson SS, Su EP. Short-term complications after revision hip arthroplasty for prosthetic joint infection are increased relative to noninfectious revisions. J Arthroplasty 2018; 33 (09) 2997-3002
    CrossrefPubMedGoogle Scholar
  • 22 Masters JPM, Smith NA, Foguet P, Reed M, Parsons H, Sprowson AP. A systematic review of the evidence for single stage and two stage revision of infected knee replacement. BMC Musculoskelet Disord 2013; 14: 222
    CrossrefPubMedGoogle Scholar
  • 23 Jiang HJ, Ciccone K, Urlaub CJ, Boyd D, Meeks G, Horton L. Adapting the HCUP QIs for hospital use: the experience in New York State. Jt Comm J Qual Improv 2001; 27 (04) 200-215
    PubMedGoogle Scholar
  • 24 Klement MR, Nickel BT, Penrose CT. , et al. Psychiatric disorders increase complication rate after primary total knee arthroplasty. Knee 2016; 23 (05) 883-886
    CrossrefPubMedGoogle Scholar
  • 25 Bozic KJ, Lau E, Ong K. , et al. Risk factors for early revision after primary total hip arthroplasty in Medicare patients. Clin Orthop Relat Res 2014; 472 (02) 449-454
    CrossrefPubMedGoogle Scholar
  • 26 Wieser K, Zingg PO, Betz M, Neubauer G, Dora C. Total hip replacement in patients with history of illicit injecting drug use. Arch Orthop Trauma Surg 2012; 132 (07) 1037-1044
    CrossrefPubMedGoogle Scholar
  • 27 Browne JA, Sandberg BF, D'Apuzzo MR, Novicoff WM. Depression is associated with early postoperative outcomes following total joint arthroplasty: a nationwide database study. J Arthroplasty 2014; 29 (03) 481-483
    CrossrefPubMedGoogle Scholar
  • 28 Liu J, Wilson L, Poeran J. , et al. Trends in total knee and hip arthroplasty recipients: a retrospective cohort study. Reg Anesth Pain Med 2019; 44 (09) 854-859
    CrossrefPubMedGoogle Scholar
  • 29 Duivenvoorden T, Vissers MM, Verhaar JAN. , et al. Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study. Osteoarthritis Cartilage 2013; 21 (12) 1834-1840
    CrossrefPubMedGoogle Scholar
  • 30 Wilson L, Bekeris J, Fiasconaro M. , et al. Risk factors for new-onset depression or anxiety following total joint arthroplasty: the role of chronic opioid use. Reg Anesth Pain Med 2019 (e-pub ahead of print). doi: 10.1136/rapm-2019-100785
    PubMedGoogle Scholar
  • 31 Rotevatn TA, Bøggild H, Olesen CR. , et al. Alcohol consumption and the risk of postoperative mortality and morbidity after primary hip or knee arthroplasty—A register-based cohort study. PLoS One 2017; 12 (03) e0173083
    CrossrefPubMedGoogle Scholar
  • 32 Jenkins PJ, Duckworth AD, Robertson FPC, Howie CR, Huntley JS. Profiles of biomarkers of excess alcohol consumption in patients undergoing total hip replacement: correlation with function. ScientificWorldJournal 2011; 11: 1804-1811
    CrossrefPubMedGoogle Scholar
  • 33 Triantafyllopoulos GK, Memtsoudis SG, Zhang W, Ma Y, Sculco TP, Poultsides LA. Periprosthetic infection recurrence after 2-stage exchange arthroplasty: failure or fate?. J Arthroplasty 2017; 32 (02) 526-531
    CrossrefPubMedGoogle Scholar
  • 34 Bozic KJ, Ward DT, Lau EC. , et al. Risk factors for periprosthetic joint infection following primary total hip arthroplasty: a case control study. J Arthroplasty 2014; 29 (01) 154-156
    CrossrefPubMedGoogle Scholar
  • 35 Radtke K, Tetzlaff T, Vaske B. , et al. Arthroplasty-center related retrospective analysis of risk factors for periprosthetic joint infection after primary and after revision Total Hip Arthroplasty. Technol Health Care 2016; 24 (05) 721-728
    CrossrefPubMedGoogle Scholar
  • 36 Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD. ; INFORM Team. Patient-related risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis. PLoS One 2016; 11 (03) e0150866
    CrossrefPubMedGoogle Scholar
  • 37 Takayanagi Y, Spira AP, Roth KB, Gallo JJ, Eaton WW, Mojtabai R. Accuracy of reports of lifetime mental and physical disorders: results from the Baltimore Epidemiological Catchment Area study. JAMA Psychiatry 2014; 71 (03) 273-280
    CrossrefPubMedGoogle Scholar
  • 38 Berthelsen CL. Evaluation of coding data quality of the HCUP National Inpatient Sample. Top Health Inf Manage 2000; 21 (02) 10-23
    PubMedGoogle Scholar