TY - JOUR
T1 - Reducing Risk in Total Joint Arthroplasty
T2 - Assessing Mental Health, Mood, and Movement Disorders
AU - Keswani, Aakash
AU - Chen, Darwin
N1 - Funding Information:
This project was supported by an unrestricted grant from KCI, an Acelity company.
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Preoperative and postoperative mental health status (MHS) of total joint arthroplasty patients can affect immediate and long-term outcomes following surgery. Alterations in MHS can be acute or chronic. The most common etiologies include acute changes due to (1) delirium or stroke, (2) movement disorders (Alzheimer dementia, Parkinson disease, multiple sclerosis, epilepsy), and (3) mood/behavior disorders (major depressive disorder, anxiety, bipolar disorder, schizophrenia). Across etiologies, alterations in MHS are associated with worse clinical/patient-reported outcomes and greater total cost of care. Prevention via pharmacologic and nonpharmacologic approaches is the cornerstone of management for changes in MHS due to postoperative delirium/stroke. Parkinson disease, multiple sclerosis, and epilepsy must be addressed presurgery and postsurgery via tailored care pathways to minimize complications, limit disease progression, and ensure maximal functional recovery. Major depressive disorder, anxiety, bipolar, and schizophrenia require screening and proactive, longitudinal treatment where from all members of the care team. Beyond reviewing outcomes impact and management of MHS-altering conditions in arthroplasty patients, we provide a framework for evidence-based interventions organized by disease-type to enable effective perioperative optimization and postoperative care for these patients.
AB - Preoperative and postoperative mental health status (MHS) of total joint arthroplasty patients can affect immediate and long-term outcomes following surgery. Alterations in MHS can be acute or chronic. The most common etiologies include acute changes due to (1) delirium or stroke, (2) movement disorders (Alzheimer dementia, Parkinson disease, multiple sclerosis, epilepsy), and (3) mood/behavior disorders (major depressive disorder, anxiety, bipolar disorder, schizophrenia). Across etiologies, alterations in MHS are associated with worse clinical/patient-reported outcomes and greater total cost of care. Prevention via pharmacologic and nonpharmacologic approaches is the cornerstone of management for changes in MHS due to postoperative delirium/stroke. Parkinson disease, multiple sclerosis, and epilepsy must be addressed presurgery and postsurgery via tailored care pathways to minimize complications, limit disease progression, and ensure maximal functional recovery. Major depressive disorder, anxiety, bipolar, and schizophrenia require screening and proactive, longitudinal treatment where from all members of the care team. Beyond reviewing outcomes impact and management of MHS-altering conditions in arthroplasty patients, we provide a framework for evidence-based interventions organized by disease-type to enable effective perioperative optimization and postoperative care for these patients.
KW - mental health
KW - mental status
KW - total joint replacement
KW - total knee arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=85064931086&partnerID=8YFLogxK
U2 - 10.1097/BTO.0000000000000381
DO - 10.1097/BTO.0000000000000381
M3 - Article
AN - SCOPUS:85064931086
SN - 0885-9698
VL - 34
SP - 193
EP - 199
JO - Techniques in Orthopaedics
JF - Techniques in Orthopaedics
IS - 3
ER -