Psychosis Associated With Increased Complications Following Total Joint Arthroplasty

total joint arthroplasty
total joint arthroplasty
Investigators seek the association between psychosis and complication risk after total joint arthroplasty.

Patients with bipolar disorder or schizophrenia were at an increased risk for postsurgical complications, including periprosthetic joint infections and the requirement of aseptic and mechanical revisions, according to the results of a study published in The Journal of Arthroplasty.

In this retrospective study, researchers evaluated the outcomes of total joint arthroplasties performed in patients with bipolar disorder (n=134) or with schizophrenia (n=22). Revisions and readmissions at 90 days, 1 year, and 2 years were compared in patients with schizophrenia or bipolar disorder and matched controls without psychosis (n=423).

Schizophrenia or bipolar disorder was associated with an increased likelihood of periprosthetic joint infection at 90 days (odds ratio [OR] 3.34; P =.049), 2 years (OR 3.94; P =.004), or any time point (OR 4.32; P =.002).

In Kaplan-Meier survivorship analysis, patients with schizophrenia or bipolar disorder had significantly reduced infection-free implant survivorship compared with controls (P =.001).

Patients with schizophrenia or bipolar disorder had increased odds of aseptic readmissions at all time points evaluated: 90 days (OR 2.92; P =.003), 1 year (OR 2.24; P =.001), and 2 years (OR 1.83; P =.008). A diagnosis of schizophrenia or bipolar disorder was also associated with increased odds of mechanical revision at all time points: 90 days (OR 13.97; P =.017), 1 year (OR 4.76; P =.003), and 2 years (OR 4.18; P =.001).

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“Patients with serious mental illnesses, including schizophrenia or bipolar disorder, likely have multiple potential barriers to self-care post-operatively and have an increased risk for undergoing revision [total joint arthroplasty] for [periprosthetic joint infection] and mechanical complications, particularly dislocation,” the study investigators concluded. “Surgeons should be aware of this high-risk population.”


Kheir MM, Kheir YNP, Tan TL, Ackerman CT, Rondon AJ, Chen AF. Increased complications for schizophrenia and bipolar disorder patients undergoing total joint arthroplasty [published online December 14, 2017]. J Arthroplasty. doi:10.1016/j.arth.2017.12.006