Clinical Scorecard: Evaluating the Results of Contemporary Total Joint Arthroplasty in Dementia Patients: A Systematic Review of Perioperative Challenges and Considerations

At a Glance

Key Highlights

• Patients with dementia undergoing TJA have higher risks of perioperative complications, mortality, prolonged hospital stays, and discharge to long-term care.
• Cognitive deficits contribute to challenges such as delirium, infection, and rehabilitation non-compliance requiring tailored perioperative management.
• Dementia is underrepresented in orthopedic datasets, and evidence on its impact on TJA outcomes is limited and heterogeneous.

Guideline-Based Recommendations

Diagnosis

• Screen for cognitive impairment and document dementia diagnosis prior to TJA planning.
• Assess dementia severity and comorbidities to inform surgical risk stratification.

Management

• Implement tailored perioperative care strategies addressing delirium prevention and rehabilitation support.
• Consider multidisciplinary approaches involving geriatrics, orthopedics, and rehabilitation specialists.

Monitoring & Follow-up

• Closely monitor for postoperative complications including delirium and infections.
• Track functional recovery and adherence to rehabilitation protocols post-TJA.

Risks

• Recognize increased risks of mortality, complications, and discharge to skilled nursing or long-term care facilities in dementia patients.
• Account for frailty and comorbidities that may exacerbate perioperative risks.

Patient & Prescribing Data

Patients with dementia undergoing total hip or knee arthroplasty

Higher complication rates and rehabilitation challenges necessitate individualized perioperative management and discharge planning.

Clinical Best Practices

• Use standardized cognitive assessments preoperatively to identify dementia and tailor care plans.
• Engage multidisciplinary teams to optimize perioperative and postoperative management.
• Develop protocols to prevent and manage delirium and support rehabilitation adherence in cognitively impaired patients.

References

• World Health Organization Dementia Fact Sheet
• Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement
• PROSPERO Registration CRD420251163436