Patients With Multiple Sclerosis are at Increased Risk for Postoperative Complications Following Total Hip and Knee Arthroplasty

Anticoagulant drugs reduce the risk of venous thromboembolic events after total hip and knee arthroplasty. However, the use of current drugs, such as low molecular weight heparins, is hampered by their subcutaneous route of administration. The use of vitamin K antagonists is hampered by the requirement for routine coagulation monitoring and dose titration to provide effective anticoagulation without an increased risk of bleeding and numerous food and drug interactions. Clearly, there is a need for new oral, fixed-dose anticoagulant drugs that do not require coagulation monitoring, while demonstrating similar or better efficacy and safety profiles when compared with current agents.

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POS0098 THE INFLUENCE OF THE ACTIVITY OF RHEUMATOID ARTHRITIS TO INFECTIOUS AND WOUND COMPLICATIONS AFTER TOTAL HIP AND KNEE ARTHROPLASTY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.626 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 259.2-259

Author(s):

A. Khramov ◽

M. Makarov ◽

S. Makarov ◽

S. Maglevaniy ◽

E. Naryshkin ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Knee Arthroplasty ◽

Periprosthetic Infection ◽

Underlying Disease ◽

Infectious Complications ◽

Wound Complications ◽

Activity Levels ◽

Total Hip ◽

Increased Risk ◽

Hip And Knee Arthroplasty

Background:Surgical treatment of patients with rheumatoid arthritis (RA) is associated with an increased risk of complications. This is due to the presence of inflammation, many variants of the disease, reduced physical activity, severity of functional disorders, prolonged therapy with glucocorticoids, disease-modifying antirheumatic drugs (DMARDs) and biological DMARDs, osteoporosis, as well as activity of the underlying disease.Objectives:to conduct a comparative analysis of the influence of RA activity levels on infectious complications (periprosthetic infection) and wound complications (poor healing, divergence, necrosis of the wound edges) after hip and knee arthroplasty in RA patients.Methods:1113 arthroplasties were analyzed in patients with RA, which were performed between 2002 and 2019. Of these, 649 total knee arthroplasties and 464 total hip arthroplasties were performed.Results:Infectious complications after total hip and knee arthroplasty did not occur at 0 grade of disease activity (remission). At the I grade of activity, periprosthetic infections were detected with a frequency of 0.31%, at the II grade – 0.89%, and at the III level in 3.06% of cases.Complications from the operative wound occurred in 0.91% of cases with I grade of activity, at II grade with a frequency of 5.68%, and at III – 6.98%. There were no cases of complications from the wound in patients with remission of RA.Statistical analysis of the obtained data revealed a significantly higher number of complications in the group of RA patients (p<0.005). During analyzing each type of complication, significant differences were also obtained (p<0.005).Conclusion:Risk of periprosthetic infection and complications from the wound is several times higher in patients with a high grade of RA activity. This means that performing arthroplasty, as well as other operations, in patients with high RA activity correlates to a high risk of complications.Disclosure of Interests:None declared

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Comparison of Postoperative Complications and Survivorship of Total Hip and Knee Arthroplasty in Dialysis and Renal Transplantation Patients

The Journal of Arthroplasty ◽

10.1016/j.arth.2019.10.038 ◽

2020 ◽

Vol 35 (4) ◽

pp. 971-975 ◽

Cited By ~ 3

Author(s):

Daisuke Inoue ◽

Hamidreza Yazdi ◽

Karan Goswami ◽

Timothy L. Tan ◽

Javad Parvizi

Keyword(s):

Renal Transplantation ◽

Postoperative Complications ◽

Knee Arthroplasty ◽

Total Hip ◽

Hip And Knee Arthroplasty

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Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty

Journal of Personalized Medicine ◽

10.3390/jpm11111223 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1223

Author(s):

Axel Jakuscheit ◽

Nina Schaefer ◽

Johannes Roedig ◽

Martin Luedemann ◽

Sebastian Philipp von Hertzberg-Boelch ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Transfusion ◽

Knee Arthroplasty ◽

Haemoglobin Concentration ◽

Blood Transfusions ◽

Preoperative Treatment ◽

Complication Rates ◽

Total Hip ◽

Hip And Knee Arthroplasty ◽

Low Bmi

Background: The primary aim of this study was to identify modifiable patient-related predictors of blood transfusions and perioperative complications in total hip and knee arthroplasty. Individual predictor-adjusted risks can be used to define preoperative treatment thresholds. Methods: We performed this retrospective monocentric study in orthopaedic patients who underwent primary total knee or hip arthroplasty. Multivariate logistic regression models were used to assess the predictive value of patient-related characteristics. Predictor-adjusted individual risks of blood transfusions and the occurrence of any perioperative adverse event were calculated for potentially modifiable risk factors. Results: 3754 patients were included in this study. The overall blood transfusion and complication rates were 4.8% and 6.4%, respectively. Haemoglobin concentration (Hb, p < 0.001), low body mass index (BMI, p < 0.001) and estimated glomerular filtration rate (eGFR, p = 0.004) were the strongest potentially modifiable predictors of a blood transfusion. EGFR (p = 0.001) was the strongest potentially modifiable predictor of a complication. Predictor-adjusted risks of blood transfusions and acute postoperative complications were calculated for Hb and eGFR. Hb = 12.5 g/dL, BMI = 17.6 kg/m2, and eGFR = 54 min/mL were associated, respectively, with a 10% risk of a blood transfusion, eGFR = 59 mL/min was associated with a 10% risk of a complication. Conclusion: The individual risks for blood transfusions and acute postoperative complications are strongly increased in patients with a low preoperative Hb, low BMI or low eGFR. We recommend aiming at a preoperative Hb ≥ 13g/dL, an eGFR ≥ 60 mL/min and to avoid a low BMI. Future studies must show if a preoperative increase of eGFR and BMI is feasible and truly beneficial.

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Urinary Self-Catheterization is Not Associated with Increased Risk of Major Complications Following Total Hip and Knee Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.04.017 ◽

2020 ◽

Vol 35 (9) ◽

pp. 2380-2385

Author(s):

Alyssa D. Althoff ◽

Dennis Q. Chen ◽

Nicole D. Quinlan ◽

Brian C. Werner ◽

James A. Browne

Keyword(s):

Knee Arthroplasty ◽

Total Hip ◽

Major Complications ◽

Increased Risk ◽

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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Combined total hip and knee arthroplasty during the same hospital admission

The Bone & Joint Journal ◽

10.1302/0301-620x.101b5.bjj-2018-1438 ◽

2019 ◽

Vol 101-B (5) ◽

pp. 573-581

Author(s):

A. M. Almaguer ◽

K. H. Cichos ◽

G. McGwin Jr ◽

J. M. Pearson ◽

B. Wilson ◽

...

Keyword(s):

Knee Arthroplasty ◽

Joint Infection ◽

Hospital Costs ◽

Revision Arthroplasty ◽

Total Hip ◽

Vein Thrombosis ◽

Prosthetic Joint ◽

Increased Risk ◽

Hip And Knee Arthroplasty ◽

Deep Vein

Aims The purpose of this study was to compare outcomes of combined total joint arthroplasty (TJA) (total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed during the same admission) versus bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJAs performed on the same day were compared with those staged within the same admission episode. Patients and Methods Data from the National (Nationwide) Inpatient Sample recorded between 2005 and 2014 were used for this retrospective cohort study. Postoperative in-hospital complications, total costs, and discharge destination were reviewed. Logistic and linear regression were used to perform the statistical analyses. p-values less than 0.05 were considered statistically significant. Results Combined TJA was associated with increased risk of deep vein thrombosis, prosthetic joint infection, irrigation and debridement procedures, revision arthroplasty, length of stay (LOS), and in-hospital costs compared with bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJA performed on separate days of the same admission showed no statistically significant differences when compared with same-day combined TJA, but trended towards decreased total costs and total complications despite increased LOS. Conclusion Combined TJA is associated with increased in-hospital complications, LOS, and costs. We do not recommend performing combined TJA during the same hospital stay. Cite this article: Bone Joint J 2019;101-B:573–581.

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