Postoperative Delirium and Postoperative Cognitive Dysfunction in Patients with Elective Hip or Knee Arthroplasty: A Narrative Review of the Literature

Petros Kitsis, Theopisti Zisimou, Ioannis Gkiatas, Ioannis Kostas-Agnantis, Ioannis Gelalis, Anastasios Korompilias, Emilios Pakos, Petros Kitsis, Theopisti Zisimou, Ioannis Gkiatas, Ioannis Kostas-Agnantis, Ioannis Gelalis, Anastasios Korompilias, Emilios Pakos

Abstract

Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common complications following total knee arthroplasty (TKA) and total hip arthroplasty (THA), affecting the length of hospital stay and increasing medical complications. Although many papers have been published on both conditions in this setting, no reviews have currently been written. Thus, the purpose of our study is to summarize the current literature and provide information about POD and POCD following elective THA or TKA. Our literature search was conducted in the electronic databases PubMed and the Cochrane library. We found that POD is a common complication following elective THA or TKA, with a median incidence of 14.8%. Major risk factors include older age, cognitive impairment, dementia, preoperative (pre-op) comorbidities, substance abuse, and surgery for fracture. Diagnosis can be achieved using tools such as the confusion assessment method (CAM), which is sensitive, specific, reliable, and easy to use, for the identification of POD. Treatment consists of risk stratification and the implementation of a multiple component prevention protocol. POCD has a median incidence of 19.3% at 1 week, and 10% at 3 months. Risk factors include older age, high BMI, and cognitive impairment. Treatment consists of reversing risk factors and implementing protocols in order to preserve physiological stability. POD and POCD are common and preventable complications following TKA and THA. Risk stratification and specific interventions can lower the incidence of both syndromes. Every physician involved in the care of such patients should be informed on every aspect of these conditions in order to provide the best care for their patients.

Keywords: cognitive dysfunction; delirium; elective total hip replacement; elective total knee replacement; mental disorder; neurobehavioral manifestations.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Scheme 1
Scheme 1
Qualitative evaluation of studies with MINORS scores and criteria used when contradicting evidence were present.
Scheme 2
Scheme 2
How to approach patient; risk stratification and multiple component prevention protocol for POD.
Figure 1
Figure 1
Incidence of early/late/1-year POCD and number of studies reporting it, respectively.
Scheme 3
Scheme 3
Bundled interventions for POCD risk reduction.

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Source: PubMed

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