Impact of Recent COVID-19 Infection on Total Joint Arthroplasty Outcomes

It remains unclear whether a history of recent COVID-19 infection affects the outcomes and risks of complications of total joint arthroplasty (TJA).

E.M. Forlenza et al conducted a study to compare the outcomes of TJA in patients who have and have not had a recent COVID-19 infection. The study was conducted at Rush University Medical Center, Chicago, Illinois. The study has been published in “The Journal of Arthroplasty.”

A large national database was queried for patients undergoing total hip and total knee arthroplasty. Patients who had a diagnosis of COVID-19 within 90-days preoperatively were matched to patients who did not have a history of COVID-19 based on age, sex, Charlson Comorbidity Index, and procedure. A total of 31,453 patients undergoing TJA were identified, of which 616 (2.0%) had a preoperative diagnosis of COVID-19. Of these, 281 COVID-19 positive patients were matched with 281 patients who did not have COVID-19.

The 90-day complications were compared between patients who did and did not have a diagnosis of COVID-19 at 1, 2, and 3 months preoperatively. Multivariate analyses were used to further control for potential confounders.

Key Findings of the Study

• Multivariate analysis of the matched cohorts showed that COVID-19 infection within 1 month prior to TJA was associated with an increased rate of postoperative deep vein thrombosis (odds ratio [OR]: 6.50, 95% confidence interval: 1.48-28.45, P = .010) and venous thromboembolic events (odds ratio: 8.32, confidence interval: 2.12-34.84, P = .002).
• COVID-19 infection within 2 and 3 months prior to TJA did not significantly affect outcomes.

The authors concluded that – “COVID-19 infection within 1 month prior to TJA significantly increases the risk of postoperative thromboembolic events; however, complication rates returned to baseline after that time point. As surgeons face a significant backlog of cases, they must balance patient safety with the desire to treat patients adversely affected by COVID-19 delays. Surgeons should consider delaying elective total hip arthroplasty and total knee arthroplasty until 1 month after a COVID-19 infection.”

Further Reading

Elective Joint Arthroplasty Should be Delayed by One Month After COVID-19 Infection to Prevent Postoperative Complications
Enrico M. Forlenza, Joseph Serino et al
The Journal of Arthroplasty
https://doi.org/10.1016/j.arth.2023.02.032