Aspirin as Thromboprophylaxis in Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis

ABSTRACT Intraarticular corticosteroid injection (ICSI) is a widely practiced management for hip and knee osteoarthritis. Imposed delays to arthroplasty during coronavirus disease 2019 pandemic have led us to postulate that many patients have opted for recent ICSI. We compared the odds of prosthetic joint infection (PJI) in patients who were or were not administered ICSI within 12 months prior to hip or knee arthroplasty. A systematic search of PubMed, Embase, The Cochrane Library and Web of Science was performed in February 2021, with studies assessing the effect of ICS on PJI rates identified. All studies, which included patients that received ICSI in the 12 months prior to primary hip and knee arthroplasty, were included. In total 12 studies were included: four studies with 209 353 hips and eight studies with 438 440 knees. ICSI administered in the 12 months prior to hip arthroplasty increased the odds of PJI [odds ratio (OR) = 1.17, P = 0.04]. This was not the case for knees. Subgroup analysis showed significantly higher odds of PJI in both hip [OR = 1.45, P = 0.002] and knee arthroplasty [OR = 2.04; P = 0.04] when ICSI was within the preceding 3 months of surgery. A significantly higher odds of PJI were seen in patients receiving ICSI within the 12 months prior to hip arthroplasty. Subgroup analysis showed increased odds of PJI in both hip and knee arthroplasty, in patients receiving ICSI within 3 months prior to their arthroplasty. We recommend delaying knee arthroplasty for at least 3 months after ICSI and possibly longer for hip arthroplasty. Level of Evidence Level III - Systematic Review of Level II and III Studies.

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The impact of enhanced recovery after surgery on total joint arthroplasty: A protocol for systematic review and meta-analysis (Preprint)

10.2196/preprints.25581 ◽

2020 ◽

Author(s):

Siddharth Rele ◽

Cade Shadbolt ◽

Chris Schilling ◽

Nicholas F Taylor ◽

Michelle M Dowsey ◽

...

Keyword(s):

Systematic Review ◽

Health Service ◽

Knee Arthroplasty ◽

Total Joint Arthroplasty ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Meta Analysis ◽

Joint Arthroplasty ◽

Total Hip ◽

Hip And Knee Arthroplasty

BACKGROUND The number of total joint arthroplasty being performed is increasing worldwide. To match this increasing demand, there has been focus on hastening patients’ recovery of function. This effort has culminated in formulation of enhanced recovery for surgery (ERAS) strategies. However, with evolving ERAS programs and new recommendations, a review of current evidence is required to provide clinicians with up-to-date information about its effect on outcomes for total joint arthroplasty. OBJECTIVE This study outlines the protocol for a systematic review and meta-analysis that aims to assess the utility of enhanced recovery after surgery programs on patient, health services and economic outcomes for primary, elective total hip and knee arthroplasty. METHODS A systematic search will be conducted in Medline (OVID), EMCARE (OVID), Web of Science, CINAHL, National Health Service Economic Evaluations Database and the Cochrane Library. Analytical, observational and experimental designs will be included in this systematic review. Only studies including patients undergoing primary, total knee and hip arthroplasty comparing ERAS programs with conventional surgery and postoperative care will be included. Data related to patient outcomes, health service outcomes, safety and economic evaluation will be extracted. RESULTS The search terms have been finalized, and the final primary database search will be completed in November 2020. The results of this systematic review will be disseminated in a peer-reviewed journal. CONCLUSIONS This protocol will guide a systematic review assessing outcomes associated with ERAS surgery in primary, total hip and knee arthroplasty CLINICALTRIAL Open Science Framework. Doi: 10.17605/OSF.IO/Y4BHS

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Comparison of outpatient versus inpatient total hip and knee arthroplasty: A systematic review and meta-analysis of complications

Journal of Orthopaedics ◽

10.1016/j.jor.2019.08.022 ◽

2020 ◽

Vol 17 ◽

pp. 38-43 ◽

Cited By ~ 3

Author(s):

Joshua Xu ◽

Jacob Y. Cao ◽

Gurpreet S. Chaggar ◽

Jonathan J. Negus

Keyword(s):

Systematic Review ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Total Hip ◽

Hip And Knee Arthroplasty

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Outcome of total hip and knee arthroplasty in HIV-infected patients: A systematic review

Orthopedic Reviews ◽

10.4081/or.2019.8020 ◽

2019 ◽

Vol 11 (1) ◽

Cited By ~ 1

Author(s):

Shane C. O'Neill ◽

Joseph M. Queally ◽

Anne Hickey ◽

Kevin J. Mulhall

Keyword(s):

Systematic Review ◽

Knee Arthroplasty ◽

Normal Population ◽

Meta Analysis ◽

Secondary Outcome ◽

Hiv Positive ◽

Significant Heterogeneity ◽

Total Hip ◽

Increased Risk ◽

Hip And Knee Arthroplasty

Significant advances in the treatment of Human Immunodeficiency Virus (HIV) have occurred in recent times, with life expectancy now approaching the normal population. Therefore, patients with HIV will increasingly be undergoing joint replacement in the future, however concerns remain regarding the complications and outcome in this patient cohort. The aim was to assess the outcome of total hip and knee arthroplasty in HIV-infected patients. A systematic search of the literature using MOOSE reporting guidelines was performed to assess the outcome of hip and knee arthroplasty in HIV-infected patients. The primary outcome was infection. Secondary outcome was all-cause revision. The search yielded 552 results, of which 19 met the inclusion criteria, comprising 5.819.412 joint replacements. The overall quality of the studies was poor with significant heterogeneity between the studies. Infection and revision appeared to be more likely to occur in HIV positive patients compared to HIV negative patients. A subgroup analysis of four studies revealed a risk ratio of 3.31 and 2.25 for increase in infection and revision respectively in HIV positive patients. This systematic review and meta-analysis demonstrates an increased risk of infection and revision in HIV infected patients undergoing total hip and knee arthroplasty. However, these findings are based on poor quality evidence in a limited number of studies and need to be interpreted with caution. Further research should concentrate on large, well-designed, prospective studies, that control for co-morbidities and employ standardised outcome measures to allow for direct comparison.

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