Hip and knee replacement—do we need to bother about psychiatry?

In the present issue of Acta Orthopaedica, Gylvin et al. (2016) present a narrative review on the negative effects of psychiatric medication and psychiatric disease on the perioperative course and long-term outcome after knee or hip replacement. They also refer to their own experience from a recently published study of 8,757 procedures, which is one of very few prospective studies in this area (Jorgensen et al. 2015). That study found psychiatric disease/psychopharmacological treatment to be a risk factor for postoperative morbidity (mainly leading to prolonged hospital stay and more frequent re-admissions) after fast-track knee or hip replacement. Mortality related to surgery was 0.7% in patients with psychiatric disease and 0.2% in patients without. This increased morbidity and mortality may be due to psychiatric disease per se and/or drug-related side effects.