Effects of COVID-19 on short-term outcomes of hip arthroplasty: a multicenter, retrospective, propensity score
Shih-Hui Peng1,2, Yu-Chih Lin1,3, Chih-Hsiang Chang1,4
1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
Insights
COVID-19 infection increased the risk of postoperative pneumonia and urinary tract infections following hip arthroplasty. While not significantly raising the risk of periprosthetic joint infection, it complicated treatment due to culture-negativity.
Area of Science:
- Orthopedic surgery
- Infectious disease epidemiology
- Public health
Background:
- The COVID-19 pandemic disrupted elective surgical procedures, including hip arthroplasty.
- Understanding the impact of COVID-19 on surgical outcomes is crucial as procedures resume.
- Short-term outcomes after hip arthroplasty in the context of COVID-19 require investigation.
Purpose of the Study:
- To explore the effects of a prior COVID-19 infection on short-term outcomes after hip arthroplasty.
- To compare complication rates between hip arthroplasty patients with and without a history of COVID-19.
- To identify specific risks associated with COVID-19 in the perioperative period of hip replacement.
Main Methods:
- Multicenter, retrospective, case-control study design.
- Inclusion of hip arthroplasty patients from 2020-2022.
- Propensity score matching (PSM) to compare COVID-19 cohort (n=153) with a control cohort (n=4925).
- Assessment of primary outcomes (e.g., surgical site infection, PJI, PE) and secondary outcomes (e.g., pneumonia, UTI).
Main Results:
- Significant increases in postoperative pneumonia and urinary tract infection (UTI) rates were observed in the COVID-19 cohort post-PSM.
- The odds ratio for periprosthetic joint infection (PJI) was 1.62, but this finding was not statistically significant (p=0.3238).
- A higher rate of culture-negativity was noted in PJI cases within the COVID-19 cohort (25%).
Conclusions:
- COVID-19 infection is associated with elevated risks of postoperative pneumonia and UTI after hip arthroplasty.
- The study did not find a significant increase in 90-day mortality or major perioperative complications directly linked to COVID-19.
- Periprosthetic joint infection (PJI) remains a concern due to challenging treatment, often exacerbated by culture-negativity, potentially leading to Girdlestone procedures.
Purpose:
The Coronavirus Disease 2019 (COVID-19) pandemic delayed elective procedures such as total joint arthroplasty. As surgical volumes return to prepandemic levels, understanding the implications of COVID-19 becomes imperative. This study explored the effects of COVID-19 on the short-term outcomes of hip arthroplasty.
Methods:
This multicenter, retrospective, case-control study included patients who had undergone hip arthroplasty between 2020 and 2022. Propensity score matching (PSM) was performed to compare demographic characteristics, primary outcomes, and secondary outcomes between patients with a history of COVID-19 (COVID-19 cohort) and those without it (control cohort). The primary outcomes were surgical site infection, periprosthetic joint infection (PJI), dislocation, prosthesis loosening, deep vein thrombosis, and pulmonary embolism. The secondary outcomes were intraoperative blood loss, nerve injury, renal injury, urinary tract infection (UTI), pneumonia, and acute coronary syndrome.
Results:
The COVID-19 and control cohorts comprised 153 and 4925 patients, respectively. After PSM, significant between-cohort differences were observed in the incidence of pneumonia (p < 0.001) and UTI (p = 0.0424). The odds ratio for PJI was 1.62, which is not significant (p = 0.3238) but the culture-negativity rate is higher in the COVID-19 cohort (25%).
Conclusion:
Our findings suggest that COVID-19 only elevated risks of postoperative pneumonia and UTI after hip arthroplasty. This disease significantly increases the risk of postoperative pneumonia but not of 90-day mortality or any major perioperative complication. On the other hand, PJI still remains a concern because its treatment is challenging owing to its culture-negativity, often necessitating the Girdlestone procedure.
