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Elective Joint Arthroplasty Should be Delayed by One Month After COVID-19 Infection to Prevent Postoperative
Enrico M Forlenza1, Joseph Serino1, Matthew T Weintraub1
1Rush University Medical Center, Chicago, Illinois.
Insights
Recent COVID-19 infection within one month before total joint arthroplasty (TJA) significantly increases risks of blood clots. Delaying elective TJA for at least one month after COVID-19 infection is recommended to mitigate these risks.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Public Health
Background:
- The impact of recent COVID-19 infection on total joint arthroplasty (TJA) outcomes is not well understood.
- Assessing postoperative complication risks in TJA patients with a history of recent COVID-19 is crucial.
Purpose of the Study:
- To compare TJA outcomes in patients with and without recent COVID-19 infection.
- To identify specific risks associated with preoperative COVID-19 diagnosis.
Main Methods:
- A national database was used to identify patients undergoing total hip and knee arthroplasty.
- Patients with COVID-19 within 90 days preoperatively were matched with controls based on key demographics and comorbidities.
- 90-day postoperative complications were compared between matched cohorts, with multivariate analyses performed.
Main Results:
- COVID-19 infection within 1 month prior to TJA was linked to significantly higher rates of deep vein thrombosis and venous thromboembolic events.
- No significant increase in complications was observed for TJA performed 2 or 3 months after COVID-19 infection.
- The risk of thromboembolic events was substantially elevated (OR 6.50-8.32) for TJA within one month post-COVID-19.
Conclusions:
- A recent COVID-19 infection within one month before TJA significantly elevates the risk of postoperative thromboembolic events.
- Post-COVID-19 complication rates return to baseline after one month.
- Elective hip and knee arthroplasty should be postponed for at least one month following COVID-19 infection.
Background:
It remains unclear whether a history of recent COVID-19 infection affects the outcomes and risks of complications of total joint arthroplasty (TJA). The purpose of this study was to compare the outcomes of TJA in patients who have and have not had a recent COVID-19 infection.
Methods:
A large national database was queried for patients undergoing total hip and total knee arthroplasty. Patients who had a diagnosis of COVID-19 within 90-days preoperatively were matched to patients who did not have a history of COVID-19 based on age, sex, Charlson Comorbidity Index, and procedure. A total of 31,453 patients undergoing TJA were identified, of which 616 (2.0%) had a preoperative diagnosis of COVID-19. Of these, 281 COVID-19 positive patients were matched with 281 patients who did not have COVID-19. The 90-day complications were compared between patients who did and did not have a diagnosis of COVID-19 at 1, 2, and 3 months preoperatively. Multivariate analyses were used to further control for potential confounders.
Results:
Multivariate analysis of the matched cohorts showed that COVID-19 infection within 1 month prior to TJA was associated with an increased rate of postoperative deep vein thrombosis (odds ratio [OR]: 6.50, 95% confidence interval: 1.48-28.45, P = .010) and venous thromboembolic events (odds ratio: 8.32, confidence interval: 2.12-34.84, P = .002). COVID-19 infection within 2 and 3 months prior to TJA did not significantly affect outcomes.
Conclusion:
COVID-19 infection within 1 month prior to TJA significantly increases the risk of postoperative thromboembolic events; however, complication rates returned to baseline after that time point. Surgeons should consider delaying elective total hip arthroplasty and total knee arthroplasty until 1 month after a COVID-19 infection.
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