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

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.

Effects of anterior approach to quadratus lumborum block on postoperative cognitive function following hip surgery in elderly patients: A randomized controlled clinical trial

“…The incidence of POCD in patients with hip fractures was reported with a wide range of 6.7-75% one week after surgery and 8-45% three months after surgery [4] . The high frequency of POCD is attributed to the increasing number of hip surgeries performed on elderly patients.…”

“…However, severe surgical trauma, postoperative pain, and postoperative cognitive dysfunction (POCD) can be a considerable challenge for elderly patients undergoing hip surgery [2,3] . POCD is a common complication following hip surgery, with a median incidence of 19.3% at one week and 10% at three months [4] . It refers to a series of neurological complications, such as attention deficit and intellectual and memory impairment after surgery, which seriously affect a patient's postoperative recovery and quality of life [5] .…”

Resolvin D1: A key endogenous inhibitor of neuroinflammation

“…Hospitalization is associated with cognitive decline 78 . People, especially older patients, may experience disturbances in multiple domains such as learning and memory, orientation, and concentration after surgeries 79,80 . Finding the underlying mechanisms and resolving such disturbances after surgeries is of interest.…”

“…78 People, especially older patients, may experience disturbances in multiple domains such as learning and memory, orientation, and concentration after surgeries. 79,80 Finding the underlying mechanisms and resolving such disturbances after surgeries is of interest. In accordance, a mouse model of orthopedic surgery, which often promotes cognitive dysfunctions in humans, was introduced by Terrando et al These mice had impairment in the contextual fear response and reduced long-term potentiation (LTP) in the CA1 region of the hippocampus.…”

Data_Sheet_1.ZIP

“…Cluster analysis is better to classify the related keywords into one category. Through cluster analysis, we find that risk factors for delirium, psychometric evaluation, hospital care, and various clinical study design are also hot topics in this field (28)(29)(30).…”