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Timing of total joint arthroplasty post-COVID-19: an evaluation of the optimal window to minimize perioperative risks

Henry Hoang1, Beshoy Gabriel1, Brandon Lung1

  • 1Department of Orthopaedic Surgery, University of California Irvine, Orange, CA, 92868, USA.

Arthroplasty (London, England)
|October 4, 2024
PubMed

Insights

Patients undergoing hip or knee replacement surgery with a recent COVID-19 infection face higher risks of complications and death. A high comorbidity score further increases these risks, highlighting the need for careful preoperative screening.

Area of Science:

  • Orthopedic Surgery
  • Infectious Disease Epidemiology
  • Public Health

Background:

  • Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are prevalent orthopedic procedures.
  • The impact of COVID-19 on surgical outcomes remains a critical area of investigation.

Purpose of the Study:

  • To assess the influence of COVID-19 status on postoperative complications and mortality following THA and TKA.
  • To identify risk factors associated with adverse outcomes in patients undergoing major joint replacement surgery during the pandemic.

Main Methods:

  • Analysis of 110,186 THA and TKA cases from the National COVID-19 Cohort Collaborative (N3C).
  • Patients categorized by COVID-19 status within 12 weeks of surgery.
  • Comparison of postoperative complications (VTE, sepsis, infection, bleeding, AKI) and mortality (30-day, 1-year) using logistic regression.

Main Results:

  • COVID-19-positive THA patients showed significantly higher rates of VTE, 30-day, and 1-year mortality.
  • TKA patients with COVID-19 had a significantly higher 30-day mortality rate.
  • A positive COVID-19 diagnosis near surgery and a Charlson Comorbidity Index (CCI) > 3 were independent predictors of adverse outcomes.

Conclusions:

  • A recent COVID-19 diagnosis increases the risk of postoperative complications and mortality for THA and TKA patients.
  • Elevated CCI scores are also a significant risk factor for adverse surgical outcomes.
  • Preoperative screening and risk stratification are crucial for managing patients undergoing arthroplasty in the COVID-19 era.
Abstract

Keywords:
COVID-19Charlson Comorbidity IndexPostoperative complicationsTotal hip arthroplastyTotal knee arthroplastyVenous thromboembolism

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