Total Hip Arthroplasty in Patients With Dementia

doi:10.1016/j.arth.2020.01.070

The Journal of Arthroplasty

Volume 35, Issue 6, June 2020, Pages 1667-1670.e2

https://doi.org/10.1016/j.arth.2020.01.070 Get rights and content

Abstract

Background

There are few studies evaluating total hip arthroplasty (THA) in patients with dementia. The purpose of this study is to evaluate the rate of revision, complication, emergency department (ED) visitation, and discharge disposition in patients with dementia undergoing THA.

Methods

In this retrospective study, we evaluated patients from 2007 to 2017 using a national database. We evaluated complications in patients with a diagnosis of dementia undergoing primary THA for osteoarthritis.

Results

In patients with dementia undergoing THA, the 90-day complications were increased risk of revision, delirium, ED visitation, and skilled nursing facility disposition (P < .05). In patients with dementia undergoing THA, the 2-year complications were increased risk of delirium, ED visitation, and skilled nursing facility disposition (P < .05).

Conclusion

Patients with dementia undergoing THA are at an increased risk of complications and 90-day resource utilization.

Section snippets

Study Design

This is a retrospective, cohort study evaluating the impact of dementia on 90-day and 2-year postoperative outcomes including revision, infection, dislocation, fracture, emergency department (ED) visitation, and skilled nursing facility (SNF) placement after THA. This study was designed and reported in accordance with the STROBE statement on observational studies [12].

Variables and Data Sources

This study utilized information in the commercially available Humana database through PearlDiver’s Research Program (PearlDiver

Results

As shown in Table 1, Table 2, patients with dementia were typically older, had higher comorbidity index, and had higher rates of obesity compared to patients without dementia.

Discussion

If life expectancy increases, it is likely that there will be more people with dementia and osteoarthritis seeking THA. There is scant literature evaluating THA in patients with dementia. Dementia in THA was associated with 90-day and 2-year delirium, ED visitation, and SNF disposition. Patients and families can be aware that THA in patients with dementia is associated with an increased risk of complications. Institutions should note that these patients are likely to utilize more resources

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Cited by (10)

Comparison of Postoperative Outcomes of Patients Undergoing Total Hip and Total Knee Arthroplasty Following a Diagnosis of Dementia: A TriNetX Database Study
2024, Arthroplasty Today
As life expectancy improves for patients with dementia, the demand for mobility-improving surgeries such as total joint arthroplasty (TJA) will increase. There is little research on patients with dementia undergoing TJA, although dementia has been shown to be a risk factor for complications. The purpose of this study is to compare postoperative outcomes of patients with dementia undergoing TJA at 90 days, 2 years, and 5 years.
The TriNetX database was retrospectively queried for all patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients were divided into cohorts by preoperative diagnosis of dementia and propensity score matched. The following outcomes were evaluated between groups at 90 days, 2 years, and 5 years postoperatively: revision, resection arthroplasty, closed reduction (THA only), femur fracture plating, and prosthetic joint infection. Readmission and manipulation under anesthesia (TKA only) were evaluated at 90 days postoperatively. Univariate and multivariate analyses were performed.
After matching, there were no differences in demographics or comorbidities between groups. TKA (odds ratio [OR] = 1.75, 95% confidence interval [CI] 1.42-2.15, P < .001) and THA (OR = 2.17, 95% CI 1.92-2.45, P < .001) patients with dementia were more likely to be readmitted than patients without dementia. At 2 years (OR = 2.07, 95% CI 1.14-3.77, P = .015) and 5 years (OR = 2.14, 95% CI 1.32-3.48, P = .002) postoperatively, THA patients with dementia were more likely to have proximal femur fracture plating than patients without dementia.
Patients undergoing THA with dementia had worse outcomes than patients undergoing THA without dementia and TKA with dementia. The overall rate of complications was low, and a diagnosis of dementia should not be an absolute contraindication to proceeding with TJA.
Total shoulder arthroplasty in patients with dementia or mild cognitive impairment
2024, JSES International
Anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) reliably alleviate pain and restore shoulder function for a variety of indications. However, these procedures are not well-studied in patients with neurocognitive impairment. Therefore, the purpose of this study was to investigate whether patients with dementia or mild cognitive impairment (MCI) have increased odds of surgical or medical complications following arthroplasty.
The PearlDiver database was queried from 2010 through October 2021 to identify a cohort of patients who underwent either ATSA or RTSA and had a minimum 2-year follow-up. Current Procedural Terminology and International Classification of Diseases codes were used to stratify this cohort into three groups: (1) patients with dementia, (2) patients with MCI, and (3) patients with neither condition. Surgical and medical complication rates were compared among these three groups.
The overall prevalence of neurocognitive impairment among patients undergoing total shoulder arthroplasty was 3.0% in a cohort of 92,022 patients. Patients with dementia had increased odds of sustaining a periprosthetic humerus fracture (odds ratio [OR] = 1.46, P < .001), developing prosthesis instability (OR = 1.72, P < .001), and undergoing revision arthroplasty (OR = 1.55, P = .003) after RTSA compared to patients with normal cognition. ATSA patients with dementia did not have an elevated risk of surgical complications or revision. Conversely, RTSA patients with MCI did not have an elevated risk of complications or revision, although ATSA patients with MCI had greater odds of prosthesis instability (OR = 2.51, P = .008). Additionally, patients with neurocognitive impairment had elevated odds of medical complications compared to patients with normal cognition, including acute myocardial infarction and cerebrovascular accident.
Compared to patients with normal cognition, RTSA patients with preoperative dementia and ATSA patients with preoperative MCI are at increased risk for surgical complications. Moreover, both ATSA and RTSA patients with either preoperative MCI or dementia are at increased risk for medical complications. As the mean age in the U.S. continues to rise, special attention should be directed towards patients with neurocognitive impairment to minimize postoperative complications aftertotal shoulder arthroplasty, and the risks of this surgery more carefully discussed with patients and their families and caretakers.
Development of a Novel, Potentially Universal Machine Learning Algorithm for Prediction of Complications After Total Hip Arthroplasty
2021, Journal of Arthroplasty
Citation Excerpt :
We identified dementia as the next most important predictor. Multiple studies have shown preoperative dementia to be associated with mortality and the need for revision surgery [6,42,43]. We also show that comorbidities such as cancer, diabetes mellitus, COPD, renal failure, and chronic atherosclerosis are important contributors to the predictive accuracy of our novel ML algorithm.
As the prevalence of hip osteoarthritis increases, the number of total hip arthroplasty (THA) procedures performed is also projected to increase. Accurately risk-stratifying patients who undergo THA would be of great utility, given the significant cost and morbidity associated with developing perioperative complications. We aim to develop a novel machine learning (ML)-based ensemble algorithm for the prediction of major complications after THA, as well as compare its performance against standard benchmark ML methods.
This is a retrospective cohort study of 89,986 adults who underwent primary THA at any California-licensed hospital between 2015 and 2017. The primary outcome was major complications (eg infection, venous thromboembolism, cardiac complication, pulmonary complication). We developed a model predicting complication risk using AutoPrognosis, an automated ML framework that configures the optimally performing ensemble of ML-based prognostic models. We compared our model with logistic regression and standard benchmark ML models, assessing discrimination and calibration.
There were 545 patients who had major complications (0.61%). Our novel algorithm was well-calibrated and improved risk prediction compared to logistic regression, as well as outperformed the other four standard benchmark ML algorithms. The variables most important for AutoPrognosis (eg malnutrition, dementia, cancer) differ from those that are most important for logistic regression (eg chronic atherosclerosis, renal failure, chronic obstructive pulmonary disease).
We report a novel ensemble ML algorithm for the prediction of major complications after THA. It demonstrates superior risk prediction compared to logistic regression and other standard ML benchmark algorithms. By providing accurate prognostic information, this algorithm may facilitate more informed preoperative shared decision-making.
The association of dementia on perioperative complications following primary total hip arthroplasty for femoral neck fractures
2023, European Journal of Orthopaedic Surgery and Traumatology
Is Prior Hip Arthroscopy Associated With Higher Complication Rates or Prolonged Opioid Claims After Total Hip Arthroplasty? A Matched Cohort Study
2022, Orthopaedic Journal of Sports Medicine
Association of Medicare Mandatory Bundled Payment Reform with Joint Replacement Surgery Use for Beneficiaries with Alzheimer Disease and Related Dementias
2022, JAMA Health Forum

View all citing articles on Scopus

: Funding: There were no sources of funding for this study.

: One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2020.01.070.

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Primary HipTotal Hip Arthroplasty in Patients With Dementia

Abstract

Background

Methods

Results

Conclusion

Section snippets

Study Design

Variables and Data Sources

Results

Discussion

Mayo Clin Proc

J Arthroplasty

Int J Surg

Dementia

Joint replacement surgery in elderly patients with severe osteoarthritis of the hip or knee: decision making, postoperative recovery, and clinical outcomes

Arch Intern Med

The effect of age on pain, function, and quality of life after total hip and knee arthroplasty

Arch Intern Med

Total hip replacement in patients eighty years of age and older

J Bone Joint Surg Am

Patient-related risk factors for postoperative mortality and periprosthetic joint infection in Medicare patients undergoing TKA

Clin Orthop Relat Res

Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients

J Bone Joint Surg Am

Primary Hip
Total Hip Arthroplasty in Patients With Dementia