Patients with musculoskeletal dysplasia undergoing total joint arthroplasty are at increased risk of surgical site Infection

Patel, Harshadkumar; Cichos, Kyle H.; Moon, Andrew S.; McGwin, Gerald; Ponce, Brent A.; Ghanem, Elie

doi:10.1016/j.otsr.2019.06.013

Cited by 16 publications

(14 citation statements)

References 15 publications

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“…This increased infection might be contributed by longer and more complex procedures, possibly in the setting of prior limb procedures [18][19][20][21]. However, the large study by Patel et al encompassed all MSDs, only queried in-hospital complications, and did not use a matched comparison cohort, all of which have been addressed in the present study's methodology [15].…”

Section: Discussionmentioning

confidence: 89%

“…However, the large study by Patel et al. encompassed all MSDs, only queried in-hospital complications, and did not use a matched comparison cohort, all of which have been addressed in the present study’s methodology [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…who found patients with achondroplasia undergoing TJA had over twice the odds of perioperative bleeding issues, although Patel et al. was unable to distinguish which TJA (THA or TKA) was the driver of this association [ 15 ]. There are several possible explanations for this finding.…”

Section: Discussionmentioning

confidence: 99%

“…Increased infection risk has been noted for patients with achondroplasia undergoing a variety of orthopedic and neurosurgical procedures [16,17]. In TJA specifically, a recent study by Patel et al examining over one thousand patients with MSDs found in-hospital postoperative surgical site infections occurred at four times the rate of patients without MSD [15]. This increased infection might be contributed by longer and more complex procedures, possibly in the setting of prior limb procedures [18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…To date, the literature examining total joint arthroplasty (TJA) in achondroplasia consists of limited case series and case reports with the revision rate after THA in patients with dwarfism reported as high as 30% [ [9] , [10] , [11] , [12] , [13] , [14] ]. The only large-scale study examining outcomes across musculoskeletal dysplasias (MSDs) used the National Inpatient Sample data set and found that, despite a lower comorbidity burden and significantly younger average age at the time of surgery, the rate of in-hospital surgical site infection and postoperative hemorrhage was significantly greater in patients with MSD [ 15 ]. However, as an inpatient database, postdischarge and intermediate-term outcomes after TJA could not be assessed in this referenced study.…”

Section: Introductionmentioning

confidence: 99%

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Total Joint Arthroplasty in Patients With Achondroplasia: Comparison of 90-Day Adverse Events and 5-Year Implant Survival

et al. 2021

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Background Achondroplasia is the most common skeletal dysplasia, and total joint arthroplasty of the hip and/or knee in this patient population may present unique challenges. Methods All patients undergoing primary total hip or total knee arthroplasty (THA or TKA) for osteoarthritis in the 2010-2019 PearlDiver Mariner administrative database with least 90 days of postoperative follow-up were identified. Those with achondroplasia were matched 1:10 to patients without achondroplasia based on age, sex, and medical comorbidities. Ninety-day adverse events were assessed and compared using multivariate logistic regression. Five-year implant survival was determined and compared with Kaplan-Meier implant survival curves. Significance was set at P < .05. Results For THA, 150 patients with achondroplasia were matched to 1484 patients without and had significantly higher 90 days odds of surgical site infection (odds ratio [OR] = 3.49, P = .005) and readmission (OR = 2.35, P = .016). For TKA, 285 patients with achondroplasia were matched to 2828 without and had higher odds of aggregated any adverse event (OR = 1.52, P = .006) and transfusion (OR = 2.31, P < .001). Rates of the other studied adverse events were not significant for either set of the analyses. At 5 years, implant survival for those with and without achondroplasia was not different for those undergoing THA ( P = .321) or TKA ( P = .910). Conclusions The present study represents the largest cohort of patients with achondroplasia undergoing total joint arthroplasty to date. Although several short-term adverse events had greater odds for those with achondroplasia, 5-year survival was not different for those with or without achondroplasia after THA or TKA, supporting confidence in longer term implant success.

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