Results of Primary Total Knee Arthroplasty in Patients on Chronic Psychotropic Medications

Nolan S Smith; Sarag Abhari; Langan S Smith; Kyle M Altman; Madhusudhan R Yakkanti; Arthur L Malkani

doi:10.1016/j.arth.2024.02.037

Results of Primary Total Knee Arthroplasty in Patients on Chronic Psychotropic Medications

J Arthroplasty. 2024 Feb 23:S0883-5403(24)00136-0. doi: 10.1016/j.arth.2024.02.037. Online ahead of print.

Authors

Nolan S Smith¹, Sarag Abhari¹, Langan S Smith², Kyle M Altman¹, Madhusudhan R Yakkanti³, Arthur L Malkani⁴

Affiliations

¹ Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky.
² UofL Health, ULP Orthopedics, Louisville, Kentucky.
³ Louisville Orthopaedic Clinic, Louisville, Kentucky.
⁴ Adult Reconstruction Program, Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky.

PMID: 38401620
DOI: 10.1016/j.arth.2024.02.037

Abstract

Background: Psychotropic medications are commonly used to treat several mental health conditions. The aim of this study was to determine the impact of psychotropic medications in patients undergoing primary total knee arthroplasty (TKA) with respect to postoperative opioid use, complications, patient-reported outcome measures, and satisfaction.

Methods: This is a retrospective cohort study of 514 consecutive patients undergoing primary TKA. There were 120 patients (23.3%) who were excluded due to preoperative opioid usage. The remaining 394 patients had a minimum 1-year follow-up. Of those, 133 (34%) were on psychotropic medications preoperatively and were compared to the remaining 261 (66%) patients who were not on psychotropics. Clinical data, satisfaction, Knee Society (KS) scores, Western Ontario McMaster Universities Arthritis Index, Patient-Reported Outcomes Measurement Index Score, Forgotten Joint Scores, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, postoperative opioid medication usage, and complications were compared.

Results: The study cohort (psychotropic medications) had significantly lower postoperative KS Function, KS Knee, Forgotten Joint Scores, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Western Ontario McMaster Universities Arthritis Index, and Patient-Reported Outcomes Measurement Index Score compared to the control group. The study group had a lower overall satisfaction score (Likert scale 1 to 5) and a lower percentage of patients either satisfied or very satisfied (4.55 versus 4.79, P < .001; 92.0 versus 97.24%, P = .03, respectively). Postoperative opioid usage was significantly greater in the study group at both 6.4 weeks (range, 4 to 8) and 12-month follow-up (52.76 versus 13.33%, P < .001; 5.51 versus 0.39%, P = .002, respectively). There were no differences in complications and revisions between the groups.

Conclusions: Patients on psychotropic medications should be educated on the risk of increased opioid consumption, diminished satisfaction, and patient-reported outcome measures following primary TKA. Given the large number of patients on psychotropic medications undergoing TKA, additional studies are needed to further improve clinical outcomes in this group.

Keywords: outcomes; patient satisfaction; patient-reported outcome measures; primary TKA; psychotropic medications.