Corneal Abrasions in Total Joint Arthroplasty

Area of Science:

• Ophthalmology
• Anesthesiology
• Orthopedic Surgery

Background:

• Corneal abrasion (CA) is a common ocular complication during nonocular surgeries, often caused by corneal drying, loss of eyelid reflex, or impaired pain sensation.
• While typically healing well with lubricants, CA can cause significant ocular pain and potentially lead to complications or discharge delays, particularly with same-day outpatient procedures.

Purpose of the Study:

• To evaluate the incidence of corneal abrasion (CA) during general anesthesia in hip and knee total joint replacement procedures.
• To assess the effectiveness of a quality improvement project aimed at reducing CA in this patient population.

Main Methods:

• A quality improvement project was implemented to reduce CA during general anesthesia for total joint replacement.
• The incidence of CA was compared for six months before and six months after the intervention, analyzing 670 hip and knee arthroplasty procedures.

Main Results:

• Two cases of corneal abrasion (CA) were reported out of 670 total joint arthroplasty procedures.
• One CA occurred before and one after the intervention; both were associated with total hip arthroplasty (THA) in the lateral decubitus position and resolved without long-term deficits.

Conclusions:

• Corneal abrasion during total joint arthroplasty is a rare but potentially significant complication that warrants attention.
• Surgeons and anesthesiologists should implement preventative eye care measures, especially during THA with patients in the lateral decubitus position, to minimize risk and ensure optimal patient outcomes.
• The lateral decubitus position and extended surgery duration are identified risk factors for CA in this surgical context.