A new study published in BMJ Open has provided important insights into how older patients recover cognitively after hip replacement surgery. The research, conducted at Karolinska University Hospital in Huddinge, focused on patients undergoing total joint arthroplasty, a common operation for the elderly.

Delayed neurocognitive recovery, previously known as postoperative cognitive dysfunction, is a common problem among the elderly after surgery. This study aimed to investigate the relationship between patients' subjective experiences, performance-based tests, and biological markers in the blood to better understand this condition.

The research included 40 older patients, with an average age of 73 years, who were scheduled for hip replacement surgery. The study used a mixed-method design, meaning that both qualitative and quantitative data were collected. Neurocognitive performance was assessed using a standardised test battery, while neuroinflammation was measured through blood marker analysis. Additionally, patients' postoperative recovery was evaluated through semi-structured interviews and a postoperative recovery questionnaire.

The study found that five patients were classified as having delayed neurocognitive recovery based on performance tests. Interestingly, many patients reported cognitive symptoms, particularly related to executive functions and fatigue, even though these were not always reflected in the performance tests.

"Psychological factors, such as a sense of control and low mood, played a significant role in cognitive recovery and daily functioning," explains Anahita Amirpour, doctoral student at the Department of Neurobiology, Care Sciences, and Society and the lead author of the study. "The level of psychological well-being appears to influence postoperative cognitive recovery."

The global postoperative recovery score for the patients was 40.9, indicating a generally low quality of recovery. Many patients reported subjective cognitive decline that was not confirmed by performance tests. This discrepancy underscores the need for a comprehensive assessment of cognitive recovery.

"Future research should include longitudinal follow-ups with performance-based measurements, fatigue assessment, and evaluations of daily activities," says Anahita Amirpour. "A multidisciplinary team is crucial to effectively support patients' recovery."

This study provides valuable insights into the complex nature of cognitive recovery after surgery and emphasises the need for a holistic approach to patient care that includes psychological support.

More information: Anahita Amirpour et al, Understanding neurocognitive recovery in older adults after total hip arthroplasty—neurocognitive assessment, blood biomarkers and patient experiences: a mixed-methods study, BMJ Open (2025). DOI: 10.1136/bmjopen-2024-093872