Positive COVID-19 Diagnosis Following Primary Elective Total Joint Arthroplasty: Increased Complication and Mortality Rates

Nathanael D Heckmann; Jennifer C Wang; Amit S Piple; Gabriel J Bouz; Brian C Chung; Daniel A Oakes; Alexander B Christ; Jay R Lieberman

doi:10.1016/j.arth.2023.04.052

Positive COVID-19 Diagnosis Following Primary Elective Total Joint Arthroplasty: Increased Complication and Mortality Rates

J Arthroplasty. 2023 Sep;38(9):1682-1692.e2. doi: 10.1016/j.arth.2023.04.052. Epub 2023 May 2.

Authors

Nathanael D Heckmann¹, Jennifer C Wang¹, Amit S Piple¹, Gabriel J Bouz¹, Brian C Chung¹, Daniel A Oakes¹, Alexander B Christ¹, Jay R Lieberman¹

Affiliation

¹ Keck School of Medicine of USC, Los Angeles, California.

Abstract

Background: This study analyzed complication rates following primary elective total joint arthroplasty (TJA) in patients who subsequently contracted COVID-19.

Methods: A large national database was queried for adult patients who underwent primary elective TJA in 2020. Patients who contracted COVID-19 after total knee arthroplasty (TKA) or total hip arthroplasty (THA) underwent 1:6 matching (age [±6 years], sex, month of surgery, COVID-19-related comorbidities) to patients who did not. Differences between groups were assessed using univariate and multivariate analyses. Overall, 712 COVID-19 patients were matched to 4,272 controls (average time to diagnosis: 128-117 days [range, 0-351]).

Results: Of patients diagnosed <90 days postoperatively, 32.5%-33.6% required COVID-19-driven readmission. Discharge to a skilled nursing facility (adjusted odds ratio [aOR] 1.72, P = .003) or acute rehabilitation unit (aOR 4.93, P < .001) and Black race (aOR 2.28, P < .001) were associated with readmission after TKA. Similar results were associated with THA. COVID-19 patients were at increased risk of pulmonary embolism (aOR 4.09, P = .001) after TKA and also periprosthetic joint infection (aOR 4.65, P < .001) and sepsis (aOR 11.11, P < .001) after THA. The mortality rate was 3.51% in COVID-19 patients and 7.94% in readmitted COVID-19 patients compared to 0.09% in controls, representing a 38.7 OR and 91.8 OR of death, respectively. Similar results were observed for TKA and THA separately.

Conclusion: Patients who contracted COVID-19 following TJA were at greater risk of numerous complications, including death. These patients represent a high-risk cohort who may require more aggressive medical interventions. Given the potential limitations presently, prospectively collected data may be warranted to validate these findings.

Keywords: COVID-19; complications; mortality; total hip arthroplasty; total knee arthroplasty.

MeSH terms

Adult
Arthroplasty, Replacement, Hip* / adverse effects
Arthroplasty, Replacement, Knee* / adverse effects
COVID-19 Testing
COVID-19* / diagnosis
COVID-19* / epidemiology
Humans
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies
Risk Factors