Overlapping Lower Extremity Total Joint Arthroplasty Does Not Increase the Risk of 90-Day Complications

Although total hip arthroplasty and total knee arthroplasty commonly overlap, there are concerns about the safety and quality of this scenario. The objectives of this study were to (1) compare the operative time and the incidence of 90-day complications between overlapping and nonoverlapping total joint arthroplasties; and (2) evaluate the effect of the duration of overlap on operative time and the incidence of 90-day complications. A total of 9192 patients who underwent primary total hip arthroplasty or total knee arthroplasty at a large academic hospital from 2005 to 2014 were identified. A surgery was defined as overlapping if it had an incision to closure overlap time of at least 1 minute with any other surgery performed by the same surgeon. A total of 2669 (29%) patient procedures were classified as overlapping. Operative times and 90-day complications were compared between overlapping and nonoverlapping surgeries. Mixed effects regression models were used to assess the independent effects of overlapping surgeries. After adjusting for baseline characteristics, operative times were longer for the overlapping surgery group (P<.001). Overlapping surgeries had fewer thromboembolic events (P=.003) and periprosthetic joint infections (P=.039). Wound dehiscence (P=.662), superficial infection (P=.161), and wound hematoma (P=.511) were similar between the 2 groups. Operative times increased with increasing duration of overlap (P<.001); however, there was no association between duration of overlap and 90-day complications (P>.05 for all). Although overlapping surgeries had increased operative times, they did not appear to increase the risk of perioperative complications. This information may be helpful for scheduling overlapping procedures and counseling patients. [Orthopedics. 2018; 41(5):e695-e700.].