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Preoperative Colonoscopy Is a Risk Factor for Reoperation Following Primary Total Hip Arthroplasty: A
Talal Al-Jabri1, Matthew J Wood2, Lauren L Nowak3
1Trauma and Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, United Kingdom; Trauma and Orthopaedic Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Background:
Despite colonoscopy and total hip arthroplasty (THA) being regularly offered to the same age group of patients, there is a sparsity of literature regarding the risk of reoperation following THA and preoperative colonoscopy.
Methods:
We identified patients aged ≥ 18 years who underwent primary THA for osteoarthritis from 2003 to 2020 using administrative databases in Ontario, Canada. We identified patients who underwent colonoscopy up to one year before their THA and matched each colonoscopy patient to 10 controls using propensity score matching. We identified any instances of reoperation related to the primary THA up to five years postoperative. We used Cox Proportional Hazards models to determine the adjusted association between preoperative colonoscopy, the time to reoperation, and the area under the receiver operating curve to identify the optimal cut-off time for preoperative colonoscopy. Between 2003 and 2020, 107,000 patients underwent THA for osteoarthritis in Ontario, Canada, while 1,733 (1.6%) of these received a preoperative colonoscopy. We retained 1,515 colonoscopy patients and matched to 15,150 control patients.
Results:
In the colonoscopy group, 69 patients (4.0%) underwent a reoperation within five years postoperatively (versus 2,977 [2.8%] in the control group). The majority of reoperations in both groups were revision THA (colonoscopy: 65 of 69, 94%; control: 2,837 of 2,977, 95%). Undergoing a preoperative colonoscopy up to 12 months before THA was associated with a 1.39 (1.07 to 1.81) increased risk of reoperation within five years postoperative. This risk increased to 1.91 (1.18 to 3.12) if the colonoscopy was done within 83 days of THA.
Conclusions:
Our results indicate that THA patients who undergo a diagnostic colonoscopy up to 12 months preoperatively may have an increased risk of reoperation postoperatively. Furthermore, these data suggest a temporal relationship, where the risk may increase if the colonoscopy is performed closer to the THA.
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