Neurocognitive deficits worsen outcomes for joint replacement surgery, finds study

According to a recent study, patients with undiagnosed neurocognitive deficits are more likely to undergo knee and hip replacement surgeries and suffer worse short-term outcomes.

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In the study, patients were screened with cognitive assessments prior to undergoing a total joint arthroplasty, or replacement.

The findings suggested that people with poor assessment scores were less likely to to complete rehabilitation programs successfully and oftenrequire admission into the intensive care unit (ICU).

Our data suggest that neurocognitive impairment is highly prevalent in older individuals who are set to undergo total joint replacements, and we suspect that rates may be underestimated nationwide."

Dr James Slover, Lead Author and Associate Professor at NYU School of Medicine

He went on to say: "These patients required more hospital resources and progressed more slowly with physical therapy after surgery. Therefore, it is critical that strategies are developed to screen these patients and protocols are put in place to allocate more support to them before and after surgery."

Total joint replacements are are a common surgical intervention in older population, most of whom have significant medical comorbidities.

Former studies imply that impaired neurocognitive function may elevate the risk of complications and severe outcomes following any major surgery; however, the condition has not been well-studied in patients who undergo joint replacement surgeries.

According to AAOS, around 645,000 people undergo a total knee replacement surgery annually, and above 306,000 undergo a total hip replacement every year.

In the current study, researchers examined more than 100 patients, who were set to undergo total joint replacements, for neurocognitive impairment using three validated cognitive tests: an auditory verbal learning test for memory function and a grooved pegboard test for dexterity and coordination for both a dominant and non-dominant hand.

Ninety-nine patients had completed all the tests for before undergoing joint replacement surgeries and these were followed for at least one year. Patients, who are diagnosed with neurocognitive conditions including Alzheimer's and other dementias, were excluded from the study.

The researchers found that 53 patients (or 53%) had neurocognitive deficits recognized on at least one of the three tests and patients between the age group of 50 and 59 years suffered significant neurocognitive impairment (20 out of 34).

The highest proportion (62%, or 13 out of 21 examined patients) were seen  in patients at 70 years of age and older. Depression was linked to poorer neurocognitive scores; 13 of 17 (77%) patients with depression tested positive for impaired neurocognitive functioning across all tests, versus 48% (38 of 79) of non-depressed patients.

Among patients with neurocognitive impairment, 48% required medical consultations and ICU admission, and 64% failed to progress in physical treatments, compared with 14% and 17% of controls, respectively.

These patients were liable to be readmitted to the hospital within 30 days or one year of the procedure; however, the results were not statistically significant.

Researchers recommend future studies to focus on developing pre- and postsurgical interventions and assessments to improve the aftereffects in these patients.

If we identify patients with neurocognitive impairment prior to a joint replacement, our surgical care team can plan better and concentrate post-operative resources accordingly to make sure we are doing all we can to ensure the best outcomes."

Dr James Slover, Lead Author and Associate Professor at NYU School of Medicine

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