Increased Prevalence of Depressive Symptoms in Patients Undergoing Revision for Periprosthetic Joint Infection

Overview

Journal Arthroplast Today

Publisher Elsevier

Date 2022 Jan 3

PMID 34977309

Citations 5

Authors

Vishal Hegde

Daniel N Bracey

Roseann M Johnson

Douglas A Dennis

Jason M Jennings

Affiliations

Soon will be listed here.

Abstract

Background: Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty. Patients undergoing revision for PJI may experience psychological distress and symptoms of depression, both of which are linked to poor postoperative outcomes. We, therefore, aim to identify the prevalence of depression and depressive symptoms in patients before treatment for PJI and their link to functional outcomes.

Methods: Patients undergoing either debridement with implant retention (DAIR) or 2-stage exchange for PJI with minimum 1-year follow-up were retrospectively reviewed. The 2-stage (n = 37) and single-stage (n = 39) patients that met inclusion criteria were matched based off age (±5 years), gender, and body mass index (±5) to patients undergoing aseptic revisions. Outcomes evaluated included a preoperative diagnosis of clinical depression and preoperative and postoperative Veterans RAND 12 Item Health Survey mental component score and physical component score.

Results: Compared to matched controls, the prevalence of depressive symptoms was significantly greater in patients undergoing 2-stage exchange preoperatively (40.5% vs 10.8%, < .01) but not postoperatively (21.6% vs 10.8%, = .20). Patients undergoing DAIR with either preoperative depressive symptoms (31.3 vs 40.9, = .05) or a preoperative diagnosis of depression (27.7 vs 43.1, < .01) had significantly lower physical component scores postoperatively.

Conclusions: Patients undergoing 2-stage exchange for PJI have a four times higher prevalence of preoperative depressive symptoms than patients undergoing aseptic revision. Patients undergoing DAIR with depression or preoperative depressive symptoms have lower functional scores postoperatively. Orthopedic surgeon screening of PJI patients with referral for treatment of depression may help improve outcomes postoperatively.

Citing Articles

Prevalence of Depressive Symptoms in Patients Undergoing Aseptic Revision Total Hip Arthroplasty Differs Based on Mode of Failure.

Barton K, Bracey D, Hegde V, Pollet A, Johnson R, Dennis D Arthroplast Today. 2025; 32:101627.

PMID: 40035044 PMC: 11874526. DOI: 10.1016/j.artd.2025.101627.

Impact of Perioperative Dexamethasone Administration on Infection and Implant Osseointegration in a Preclinical Model of Orthopedic Device-Related Infection.

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The Effect of Spacer Treatment of Infected Hip and Knee Arthroplasties on Patients' Mental Health: A Narrative Review of the Literature.

Di Gennaro D, Coletta G, Festa E, De Mauro D, Rizzo M, Diana L Healthcare (Basel). 2024; 12(7).

PMID: 38610212 PMC: 11011799. DOI: 10.3390/healthcare12070790.

A Pilot Study Using a Standardized Method of Measuring Distress Demonstrates Higher Levels in Septic Revisions.

Lastinger A, Lokant M, Giertych B, Lerfald N, Makani A, Dietz M Arthroplast Today. 2024; 24:101255.

PMID: 38205061 PMC: 10776323. DOI: 10.1016/j.artd.2023.101255.

No difference in bacterial contamination of hip capsule sutures and control sutures in hip arthroplasty surgery.

van Schaik T, van Meer M, de Jong L, Goosen J, Somford M, van Susante J Antimicrob Resist Infect Control. 2023; 12(1):101.

PMID: 37710282 PMC: 10503031. DOI: 10.1186/s13756-023-01305-0.

References

Badura-Brzoza K, Zajac P, Kasperska-Zajac A, Brzoza Z, Matysiakiewicz J, Piegza M . Anxiety and depression and their influence on the quality of life after total hip replacement: preliminary report. Int J Psychiatry Clin Pract. 2014; 12(4):280-4. DOI: 10.1080/13651500802095012. View

Berend K, Lombardi Jr A, Morris M, Bergeson A, Adams J, Sneller M . Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res. 2012; 471(2):510-8. PMC: 3549176. DOI: 10.1007/s11999-012-2595-x. View

Cohen J, Hozack W, Cuckler J, Booth Jr R . Two-stage reimplantation of septic total knee arthroplasty. Report of three cases using an antibiotic-PMMA spacer block. J Arthroplasty. 1988; 3(4):369-77. DOI: 10.1016/s0883-5403(88)80040-8. View

Gold H, Slover J, Joo L, Bosco J, Iorio R, Oh C . Association of Depression With 90-Day Hospital Readmission After Total Joint Arthroplasty. J Arthroplasty. 2016; 31(11):2385-2388. DOI: 10.1016/j.arth.2016.04.010. View

Figoni A, Lalchandani G, Markes A, Sing D, Hansen E . Infection and Mechanical Complications Are Risk Factors for New Diagnosis of a Mental Health Disorder After Total Joint Arthroplasty. Arthroplast Today. 2021; 10:1-5. PMC: 8239436. DOI: 10.1016/j.artd.2021.05.019. View

Bozic K, Lau E, Kurtz S, Ong K, Rubash H, Vail T . Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. J Bone Joint Surg Am. 2012; 94(9):794-800. DOI: 10.2106/JBJS.K.00072. View

Stundner O, Kirksey M, Chiu Y, Mazumdar M, Poultsides L, Gerner P . Demographics and perioperative outcome in patients with depression and anxiety undergoing total joint arthroplasty: a population-based study. Psychosomatics. 2012; 54(2):149-57. DOI: 10.1016/j.psym.2012.08.009. View

Ellis H, Howard K, Khaleel M, Bucholz R . Effect of psychopathology on patient-perceived outcomes of total knee arthroplasty within an indigent population. J Bone Joint Surg Am. 2012; 94(12):e84. DOI: 10.2106/JBJS.K.00888. View

Walter N, Rupp M, Hierl K, Koch M, Kerschbaum M, Worlicek M . Long-Term Patient-Related Quality of Life after Knee Periprosthetic Joint Infection. J Clin Med. 2021; 10(5). PMC: 7956307. DOI: 10.3390/jcm10050907. View

10.

Gill S, Butterworth P, Rodgers B, Mackinnon A . Validity of the mental health component scale of the 12-item Short-Form Health Survey (MCS-12) as measure of common mental disorders in the general population. Psychiatry Res. 2007; 152(1):63-71. DOI: 10.1016/j.psychres.2006.11.005. View

11.

Xu C, Tan T, Li W, Goswami K, Parvizi J . Reporting Outcomes of Treatment for Periprosthetic Joint Infection of the Knee and Hip Together With a Minimum 1-Year Follow-Up is Reliable. J Arthroplasty. 2020; 35(7):1906-1911.e5. DOI: 10.1016/j.arth.2020.02.017. View

12.

Singh J, Lewallen D . Medical and psychological comorbidity predicts poor pain outcomes after total knee arthroplasty. Rheumatology (Oxford). 2013; 52(5):916-23. PMC: 3630396. DOI: 10.1093/rheumatology/kes402. View

13.

Halawi M, Cote M, Singh H, OSullivan M, Savoy L, Lieberman J . The Effect of Depression on Patient-Reported Outcomes After Total Joint Arthroplasty Is Modulated by Baseline Mental Health: A Registry Study. J Bone Joint Surg Am. 2018; 100(20):1735-1741. DOI: 10.2106/JBJS.17.01677. View

14.

Ali A, Lindstrand A, Sundberg M, Flivik G . Preoperative Anxiety and Depression Correlate With Dissatisfaction After Total Knee Arthroplasty: A Prospective Longitudinal Cohort Study of 186 Patients, With 4-Year Follow-Up. J Arthroplasty. 2016; 32(3):767-770. DOI: 10.1016/j.arth.2016.08.033. View

15.

Schwartz A, Wilson J, Farley K, Bradbury Jr T, Guild 3rd G . New-Onset Depression After Total Knee Arthroplasty: Consideration of the At-Risk Patient. J Arthroplasty. 2021; 36(9):3131-3136. DOI: 10.1016/j.arth.2021.04.008. View

16.

Alobaidi A, Nabulsi N, Talon B, Asfaw A, Zhou J, Sharp L . Depressive symptoms, mental health-related quality of life, and survival among older patients with multiple myeloma. Support Care Cancer. 2019; 28(9):4097-4106. PMC: 7308221. DOI: 10.1007/s00520-019-05246-6. View

17.

Rasouli M, Menendez M, Sayadipour A, Purtill J, Parvizi J . Direct Cost and Complications Associated With Total Joint Arthroplasty in Patients With Preoperative Anxiety and Depression. J Arthroplasty. 2015; 31(2):533-6. DOI: 10.1016/j.arth.2015.09.015. View

18.

Duivenvoorden T, Vissers M, Verhaar J, Busschbach J, Gosens T, Bloem R . Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study. Osteoarthritis Cartilage. 2013; 21(12):1834-40. DOI: 10.1016/j.joca.2013.08.022. View

19.

Wilson J, Schwartz A, Farley K, Bradbury T, Guild G . Preoperative Patient Factors and Postoperative Complications as Risk Factors for New-Onset Depression Following Total Hip Arthroplasty. J Arthroplasty. 2020; 36(3):1120-1125. DOI: 10.1016/j.arth.2020.10.009. View

20.

Jones A, Al-Naseer S, Bodger O, James E, Davies A . Does pre-operative anxiety and/or depression affect patient outcome after primary knee replacement arthroplasty?. Knee. 2018; 25(6):1238-1246. DOI: 10.1016/j.knee.2018.07.011. View