Post-Traumatic Stress Disorder as a Risk Factor for Adverse Outcomes in Total Knee Arthroplasty

Abstract

BackgroundThere is a scarcity of literature concerning individuals who have existing post-traumatic stress disorder (PTSD) and their outcomes after primary total knee arthroplasty (TKA). This study compared outcomes in patients undergoing primary TKA who have a previous history of PTSD. MethodsAn electronic healthcare database was utilized to identify patients diagnosed with PTSD undergoing TKA. Through 1:1 ratio propensity matching, these patients were matched with a cohort of non-PTSD (NPTSD) individuals. Postoperative parameters, including healthcare visits and prescriptions, were assessed within a 1-month timeframe following surgery. Complication and revision rates were evaluated after one month, six months, one year, two years, and five years. A total of 646,186 patients undergoing primary TKA were identified. Ultimately, 7,381 patients who had PTSD were propensity-matched to 7,381 NPTSD patients. ResultsPatients who had PTSD presented to the emergency department (ED) at a higher rate than NPTSD patients within seven days (OR [odds ratio]: 1.5; CI [confidence interval]: 1.0 to 2.4) postoperative. Within one month, cohorts were prescribed opioid analgesics at similar rates (OR: 0.9; CI: 0.8 to 1.1). Patients who had PTSD were found to have a higher number of infections within one month (OR: 1.7 CI: 1.2 to 2.6) and five years (OR: 1.2; CI: 1.0 to 1.5), periprosthetic fractures at six months (OR: 2.1; CI: 1.0 to 4.5) and one year (OR: 2.1; CI: 1. to 4.0), and higher revision rates at all time points. ConclusionPatients diagnosed with PTSD exhibited higher rates of periprosthetic infections at one month and five years and increased periprosthetic fracture rates at six months and one year after TKA compared to NPTSD patients. These findings underscore the importance of tailored early postoperative education and understanding outcomes for patients who have PTSD in contrast to those who do not have a diagnosis of PTSD.