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. 2023 Jul 6;5(1):34.
doi: 10.1186/s42836-023-00190-7.

Outcomes of total hip and knee arthroplasty in special populations: a synopsis and critical appraisal of systematic reviews

Dimitris Challoumas  1 , David Munn  2 , Henrietta Stockdale  2 , Nigel Ng  2 , Michael McCormick  2 , Tareq Altell  2 , Shaheer Joiya  2 , James Horton  2 , Bryn Jones  2
Affiliations

Outcomes of total hip and knee arthroplasty in special populations: a synopsis and critical appraisal of systematic reviews

Dimitris Challoumas et al. Arthroplasty. .

Abstract

Introduction: This study aimed to present and critically appraise the best available evidence investigating associations between some pre-defined patient-related characteristics and perioperative complications or other outcomes in THA and TKA.

Methods: Electronic databases were searched (Medline, EMBASE, Scopus, CENTRAL) for systematic reviews assessing the following pre-defined patient-related characteristics as possible risk factors for worse peri-operative outcomes in THA and TKA: smoking, alcohol excess, rheumatoid arthritis, human immunodeficiency virus infection, hepatitis C virus infection, mental health conditions, and solid organ transplantation. Our primary outcome was periprosthetic joint infection. Results were analysed separately for THA, TKA and THA/TKA (mixed data).

Results: Based on at least two systematic reviews being in agreement, the following patient-related characteristics were associated with increased incidence of complications as follows: a) Smoking for all-cause revision in THA, for periprosthetic joint infection in TKA and THA/TKA; b) alcohol excess for periprosthetic joint infection in THA/TKA; c) human immunodeficiency virus for periprosthetic joint infection in THA/TKA; d) hepatitis C virus for overall complications, periprosthetic joint infection and all-cause revision in THA and THA/TKA, and for overall complications in TKA. Our study found conflicting evidence for a) smoking as a risk factor for periprosthetic joint infection and aseptic loosening in THA; b) human immunodeficiency virus as a risk factor for all-cause revision for THA/TKA; c) hepatitis C virus as a risk factor for periprosthetic joint infection and all-cause revision in TKA. No certainty of evidence was assigned to these results as this was not assessed by the authors of the majority of the included systematic reviews.

Conclusion: We found that smoking, excess alcohol consumption, RA, and infection with HIV and HCV were associated with a higher incidence of periprosthetic joint infection in one or both of THA and TKA or mixed THA/TKA data. All our results should be interpreted and communicated to patients with caution as the quality of the included systematic reviews was generally poor.

Keywords: Complication; Outcome; Risk factor; Systematic review; Total hip arthroplasty; Total knee arthroplasty.

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Conflict of interest statement

None.

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