Higher Complication Rate in COVID-19 Recovered Patients Undergoing Primary Total Joint Arthroplasty.

BACKGROUND: There is limited data reviewing complication risks associated with total joint arthroplasty (TJA) after recovering from COVID-19. This study evaluated complications within 90 days of TJA in patients who had a COVID-19 diagnosis at varying intervals prior to surgery versus a non-COVID-19 cohort. METHODS: A large national database was used to identify patients diagnosed with COVID-19 in the six months prior to total hip arthroplasty (THA) or total knee arthroplasty. The incidence of complications within 90 days of surgery was recorded and compared to a COVID-19 negative control group matched 1:3 for age range in 5-year intervals, Charlson Comorbidity Index, and sex. There were 7,780 patients included in the study; 5,840 (75.1%) never diagnosed with COVID-19, 1,390 (17.9%) who had a COVID-19 diagnosis 0 to 3 months prior to surgery, and 550 (7.1%) who had a COVID-19 diagnosis 3 to 6 months prior to surgery. RESULTS: When compared to their COVID negative controls, patients who had a COVID-19 diagnosis 0 to 3 months prior to surgery had significantly higher rates of readmission (14.0 versus 11.1%, P = .001), pneumonia (2.2 versus 0.7%, P < .001), deep vein thrombosis (DVT) (3.3 versus 1.9%, P = .001), kidney failure (2.4 versus 1.4%, P = .006), and acute respiratory distress syndrome (1.4 versus 0.7%, P = .01). Patients who had a COVID-19 diagnosis 3 to 6 months prior to surgery had significantly higher rates of pneumonia (2.0 versus 0.7%, P = .002) and DVT (3.6 versus 1.9%, P = .005) when compared to their COVID negative controls. CONCLUSION: Patients diagnosed with COVID-19 within three months prior to TJA have an increased risk of 90-day postoperative complications. Risk for pneumonia and DVT remains elevated even when surgery was performed as far as 3 to 6 months after COVID-19 diagnosis.

Intra-Articular Corticosteroid Injections Into a Preexisting Total Knee Arthroplasty are Associated With Increased Risk of Periprosthetic Joint Infection and Revision.

Background: This study aims to determine the risks of periprosthetic joint infection (PJI) and revision associated with injecting a preexisting total knee arthroplasty (TKA) with intra-articular corticosteroids (IACSs). Methods: The PearlDiver database was used to identify patients who underwent elective, primary TKA between 2015 and 2019. Patients who received IACS injections into the ipsilateral knee within 1 year after their primary TKA were matched 2:1 on age, gender, and Charlson comorbidity index and compared to a no-injection control group. The incidence of PJI at 1 year postoperatively and revision at 2 years postoperatively were compared between groups. Results: A total of 27,059 patients were in the injection cohort and 54,116 patients in the control cohort. The overall PJI rate was 1.3% in the injection cohort and 0.8% in the control cohort (P < .001). The rate of PJI increased with the number of post-TKA IACS injections received: 1 injection (1.3%), 2 injections (1.4%), and >3 injections (1.8%) (P < .001 for all, compared to controls). The revision rate was 3.1% in the injection cohort and 1.3% in the control cohort (P < .001). Revision rates increased with the number of post-TKA IACS injections received: 1 injection (2.5%), 2 injections (4.2%), and >3 injections (7.3%) (P < .001 for all, compared to controls). Conclusions: IACS injections into a preexisting TKA are associated with an incremental increased risk of prosthetic joint infection and revision. Considering the potential deleterious impact of PJI and complexity of revision procedures, IACS injections into a preexisting TKA should be strongly discouraged.