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. 2024 Oct 4;6(1):53.
doi: 10.1186/s42836-024-00275-x.

Timing of total joint arthroplasty post-COVID-19: an evaluation of the optimal window to minimize perioperative risks

Henry Hoang  1 , Beshoy Gabriel  1 , Brandon Lung  1 , Steven Yang  1 , Justin P Chan  2 ; N3C Consortium
Affiliations

Timing of total joint arthroplasty post-COVID-19: an evaluation of the optimal window to minimize perioperative risks

Henry Hoang et al. Arthroplasty. .

Abstract

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed orthopedic procedures. This study aimed to evaluate the impact of COVID-19 status on postoperative complications and mortality in patients undergoing THA and TKA.

Methods: A total of 110,186 underwent either THA or TKA. Patients were grouped based on their COVID-19 status, gathered from the National COVID-19 Cohort Collaborative (N3C) in the 12 weeks preceding surgery and compared for various variables, including age, sex, BMI, and Charlson Comorbidity Index (CCI) scores. COVID-19 status was defined as a positive test result that was closest to the date of surgery regardless of testing positive previously. Postoperative complications such as venous thromboembolism (VTE), sepsis, surgical site infection, bleeding, acute kidney injury (AKI), 30-day, and 1-year all-cause mortality were examined. To compare the variables, an odds ratio with a 95% confidence interval was calculated with a significant level set at P < 0.05. Logistic regression using R programming was utilized for these calculations.

Results: Univariate analysis was performed and rates of VTE (1.02% vs. 3.35%), 30-day mortality (0.25% vs. less than 5%), and 1-year mortality (1.42% vs. 5.43%) were higher in the COVID-19-positive group for THA patients (P < 0.001). For TKA patients, only 30-day mortality was significantly higher in the COVID-19-positive group (P = 0.034). Multivariate logistic regression revealed that a positive COVID-19 diagnosis within two weeks of surgery and a CCI score > 3 were significant predictors of postoperative complications and mortality for both TKA and THA.

Conclusions: Patients with a positive COVID-19 diagnosis within 12 weeks of THA or TKA carried a significantly higher risk for postoperative complications and mortality. In addition, a CCI score > 3 is also a significant risk factor. These findings emphasize the importance of vigilant preoperative screening and risk stratification in the era of COVID-19.

Keywords: COVID-19; Charlson Comorbidity Index; Postoperative complications; Total hip arthroplasty; Total knee arthroplasty; Venous thromboembolism.

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Conflict of interest statement

I and my coauthors have no competing interests to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of study querying
Fig. 2
Fig. 2
Odds Ratios for postoperative complications in THA patients with a confirmed COVID-19 diagnosis compared to controls without a positive COVID-19 test for the 84 days prior to surgery. Error bars represent a 95% confidence interval
Fig. 3
Fig. 3
Odds Ratios for postoperative complications in TKA patients with a confirmed COVID-19 diagnosis compared to controls without a positive COVID-19 test for the 84 days prior to surgery. Error bars represent a 95% confidence interval
See this image and copyright information in PMC

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