Joint Surgery May Be Worse for Those with Mental Illness


This post was contributed to by Jennifer MacCormack.

Individuals with a psychiatric disorder often face obstacles to their medical care. The continued social stigma of mental illness can discourage some from seeking treatment. For others, mental illness may make it difficult to keep track of medications and appointments.

A 2016 study suggests that the problems may run even deeper. For some patients, mental illness may be affecting how well they recover from joint surgery.

The Mental Effects of Joint Surgery

In 2016, the Journal of Arthroplasty published an important study. The study investigated the outcome of total hip replacement surgery in patients with a diagnosed psychiatric disease. The results found these patients faced more frequent and more severe post-surgical complications than a matched control group.

Researchers analyzed Medicare data collected between 2005 and 2011. The analysis identified nearly 90,000 patients with a psychiatric disorder who had undergone total hip replacement surgery.

The mental illnesses varied between patients. The most common diagnoses in the group include:

  • Depression (95%)
  • Bipolar disorder (6%)
  • Schizophrenia (4%)

A number of patients were diagnosed as having two or more mental illnesses at once. This explains why the diagnosis group percentages add up to more than 100%.

On average, the study patients with mental illnesses were younger than the control group. These patients were also more likely to be female with other complicating illnesses prior to the surgery. Common comorbidities found in study patients included heart disease, pulmonary disease, hypertension and diabetes.

In medicine, comorbidity refers to one or more health conditions present in a patient alongside a primary health condition or disease. For example, a patient with heart disease may have the comorbidity of high blood pressure.

The comorbidities identified in the study patients with mental illness are very common in the general population. Thus, it is likely these conditions also affected patients in the control group.

However, it seems adding a psychiatric disorder to the equation means a tougher surgery and recovery. The study authors concluded that the outcomes of the surgeries of patients with mental illnesses were considerably worse than those of the control group in several ways:

  • Patients with mental illness were almost twice as likely to suffer post-operative infections requiring antibiotics or surgical intervention. 
  • Patients with mental illness were twice as likely to break or dislocate their new artificial hip joint in the first 90 days after surgery. 
  • Patients with mental illness were more likely to acquire secondary illnesses during their hospital stay, including pneumonia and respiratory failure. 
  • Patients with mental illness were more likely to need blood transfusions to correct post-surgical anemia.

How Joint Surgery Affects Psychology

The study authors suggest the problem is twofold, involving both the physical and the psychological.

For example, a patient struggling with depression may have a difficult time focusing on recovery and taking all prescribed medications. Forgetting to take antibiotics or blood thinners can create a risk of surgical site infection or systemic blood clots.

In the case of joint surgery, postoperative physical therapy is extremely important to regaining useful mobility and strengthening the muscles around the new joint. If a patient is experiencing symptoms of mental illness during recovery, important follow-up physical therapy appointments may be forgotten or skipped. Impaired mobility and continued weakness are risk factors of falls, injuries and dislocation.

Meanwhile, the higher prevalence of serious comorbidities in the population being treated for psychiatric disorders means these patients are often in unhealthier states before surgery. This can make their recovery more difficult. Heart disease and respiratory disease, in particular, make anesthesia and surgery more dangerous.

Data collected in this study suggests that a patient's preoperative health and psychological state may affect postoperative outcomes. So, how can physicians minimize risk to patients with mental illness as they approach a necessary joint surgery?

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Physicians Role in Joint Surgery for Mental Health Patients

Physicians must take the time to assess whether the patient is compliant with mental health treatments and medications. Presurgical psychological screening can be helpful in identifying patients with the highest risk of complications. Once identified, these high-risk patients could be followed more closely through the postoperative period to avoid complications or injuries.

A severely depressed patient may not be as receptive to medical instructions given post-surgery. Physicians must give clear instructions on pre-surgical preparation and post-surgical care to the patient. These instructions should also be given in writing to avoid miscommunications.

That said, doctors might not always think to ask. Patients and their families should feel comfortable speaking up during presurgical consultations. They should ask about what can be done to minimize the risks of the surgery. Patients should be honest about their lifestyle, medical conditions, and treatments. Additionally, patients should bring up any worries that might impede recovery.

A frank discussion about mental health and its effects on an individual's surgery and recovery is the best way to ensure everyone is aware of the risks.