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Background Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) produces the coronavirus disease of 2019 (COVID-19), primarily presenting with respiratory symptoms, including cough, shortness of breath, etc. Respiratory failure can present similarly to a COVID-19 infection, and COVID-19 infection can cause respiratory failure. Thus, it is important to study respiratory failure, COVID-19, and the interaction between the two in hopes of improving patient outcomes. In this study, we compared mortality rates in patients admitted with COVID-19, respiratory failure, or both. Mortality rates in our study populations were further scrutinized based on patient age. Materials and methods Respiratory failure and COVID-19 data were collected via the electronic medical records system at Freeman Health System, a 410-bed, rural hospital, in Neosho and Joplin, Missouri, from April 2020 through December 2021. The patient population included all patients admitted to the hospital with a diagnosis of COVID-19 or respiratory failure, as defined by the International Classification of Disease, Tenth Revision (ICD-10). Patients with or without COVID-19, with or without respiratory failure, and patients with respiratory failure with COVID-19 were included. Results There was a significant increase in mortality (17.28%) in patients with COVID-19 and respiratory failure (P1) compared to patients with COVID-19 who did not have respiratory failure (P2). No significance was found when comparing patients with COVID-19 and respiratory failure (P1) and patients with respiratory failure without COVID-19 (P3) (p value=0.4921). In contrast, when divided based on age, we found a significant increase in mortality in patients 65 and older with COVID-19 and respiratory failure compared to patients 65 and older with respiratory failure who did not have COVID-19 (P5). There were no significant mortality increases in other comparisons. Conclusion When comparing patient populations within the Freeman Health System, patients with COVID-19 and respiratory failure had similar mortality rates as those with respiratory failure without COVID-19, while patients with only COVID-19 had a markedly reduced mortality rate, relatively. The higher mortality rates in patients with only respiratory failure when compared to patients with both respiratory failure and COVID-19 indicate that the presence of respiratory failure likely plays a bigger role in the inflammatory response that reduces one's chance of survival in this setting. Furthermore, age was shown to be a significant risk factor as patients aged 65 and older showed a greater mortality rate when patients had both COVID-19 and respiratory failure compared to patients with both conditions below the age of 65. The decrease in immune response that results in older patients is likely the largest contributing factor along with the increased likelihood of patients in this population also having more comorbidities, further decreasing the chance of survival. Future studies can investigate alternate treatment plans for patients aged 65 and older who are at higher risk of mortality with COVID-19 and respiratory failure.
RESUMO
Introduction: Oxidized Zirconium (OXINIUM™) is a metal alloy with a ceramic surface, utilized to increase the longevity of knee and hip implantations and reduce polyethylene wear. Polyethylene-based spacers are effective in infection control and prosthetic stability. Therefore, understanding the interactions between the polyethylene spacer and metallic counterparts is essential in surgical decision-making. Furthermore, understanding how patients may present when catastrophic failure of these components arises is imperative. Herein, we present a unique case of atraumatic OXINIUM™ wear in a middle-aged female after uneventful primary total knee arthroplasty (TKA), highlighting atypical clinical features and addressing the surgical management of this unexpected implant failure. Case Report: A 51-year-old African American female presented from an outside facility with persistent left knee pain after undergoing a TKA with a Smith and Nephew OXINIUM™ coated knee. The patient presented to the senior author's clinic with worsening symptoms 2-year postoperatively from her primary left TKA by another surgeon. After a thorough work-up which was essentially unremarkable-3 years from her initial surgery - the recommendation was made for surgical revision given clinical concern for instability. During the initial surgical approach, significant sparking of the tissue was noted on the use of electrocautery. Once the capsule was dissected, black synovial fluid with soft tissue involvement was noted. Intraoperative analysis of the polyethylene spacer revealed disintegration in the medial compartment with loss of the zirconium coating along the femoral component. There was no evidence of polyethylene spacer wear within the lateral compartment. The primary components were explanted and replaced with a nickel-free implant. Following revision, the patient reported complete resolution of her symptoms with improvement in active range of motion. Conclusion: This case illustrates a unique presentation of atraumatic prosthetic surface coating failure after an uneventful primary TKA with well-aligned post-operative radiographs. Instability in the posterior stabilized total knee caused the polyethylene liner to come out of place, causing articulation of femoral and tibial components, creating the metal debris. Patients who present with persistent symptoms-of unknown etiology - after primary TKA should be considered for enhanced screenings and early surgical intervention.