{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T03:54:08Z","timestamp":1790135648375,"version":"4.0.1"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed procedures in older adults. Preoperative cognitive impairment, including mild cognitive impairment, dementia, and frailty-related cognitive decline, may adversely affect postoperative recovery and outcomes. However, the magnitude of this association in arthroplasty patients remains incompletely defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate the association between preoperative cognitive impairment and postoperative outcomes in older adults undergoing primary THA or TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed and Scopus were searched for studies evaluating preoperative cognitive status and postoperative outcomes in patients aged \u226560 years undergoing THA or TKA. Eligible studies assessed cognition using validated tools or clinical diagnoses and reported postoperative neurocognitive or clinical outcomes. A random-effects meta-analysis using the Restricted Maximum Likelihood estimator was performed. Pooled effect estimates were expressed as odds ratios (ORs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings:<\/jats:title>\n                    <jats:p>\n                      Ten studies involving 10,573 patients were included. Preoperative cognitive impairment was consistently associated with adverse postoperative outcomes, including postoperative delirium, postoperative cognitive dysfunction, long-term cognitive decline, nonhome discharge, and mortality. The pooled analysis demonstrated a significant association between preoperative cognitive impairment and adverse postoperative outcomes (OR 2.38; 95% CI 1.78\u20132.98;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Although substantial heterogeneity was observed (I\u00b2 = 76.7%), the direction of effect was consistent across studies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Preoperative cognitive impairment more than doubles the risk of adverse postoperative outcomes following THA and TKA. Routine cognitive screening should be incorporated into preoperative assessment to identify high-risk patients and support perioperative brain health strategies aimed at improving surgical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aam.aam_465_26","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T11:02:16Z","timestamp":1783422136000},"page":"1384-1392","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Cognitive Impairment and Postoperative Outcomes in Patients Undergoing Primary Total Hip Arthroplasty and Primary Total Knee Arthroplasty: A Systematic Review and Meta-analysis"],"prefix":"10.4103","volume":"25","author":[{"given":"Ravi S.","family":"Jatti","sequence":"first","affiliation":[{"name":"Department of Orthopaedic, JNMC, Belagavi, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil","family":"Manvi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic, JNMC, Belagavi, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubham","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic, JNMC, Belagavi, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"R1-20260922","doi-asserted-by":"crossref","first-page":"2151459318816482","DOI":"10.1177\/2151459318816482","article-title":"Postoperative outcomes in primary total knee arthroplasty patients with preexisting cognitive impairment: a systematic review","volume":"9","author":"Luan Erfe","year":"2018","journal-title":"Geriatric orthopaedic surgery & rehabilitation"},{"key":"R2-20260922","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jclinane.2019.01.024","article-title":"Cognitive impairment and postoperative outcomes in patients undergoing primary total hip arthroplasty: A systematic review","volume":"56","author":"Viramontes","year":"2019","journal-title":"J Clin Anesth"},{"key":"R3-20260922","doi-asserted-by":"crossref","first-page":"110883","DOI":"10.1016\/j.jclinane.2022.110883","article-title":"Postoperative outcomes in older surgical patients with preoperative cognitive impairment: A systematic review and meta-analysis","volume":"80","author":"Chen","year":"2022","journal-title":"J Clin Anesth"},{"key":"R4-20260922","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jamcollsurg.2012.02.007","article-title":"Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly","volume":"215","author":"Robinson","year":"2012","journal-title":"J Am Coll Surg"},{"key":"R5-20260922","doi-asserted-by":"crossref","first-page":"394","DOI":"10.23736\/S0375-9393.20.13903-8","article-title":"Presurgical cognitive impairment is associated with postoperative delirium and postoperative cognitive dysfunction","volume":"86","author":"Knaak","year":"2020","journal-title":"Minerva Anestesiol"},{"key":"R6-20260922","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/S0140-6736(97)07382-0","article-title":"Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. 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