Horberg Total Joints Journal Club
About HTJ Journal Club: In this recurring series, we will review recently published scientific studies on the topic of total joint replacement. These studies are used by surgeons to evaluate, update and improve their practice and the care they provide their patients. In order to provide cutting edge care, we must stay up to date on cutting edge research from around the world. Dr. Horberg will summarize the findings of the study of the day and explain how it may play a role in your care!
Paper of the Day:
“Patients With Previous COVID-19 Infection Can Safely Undergo Primary Total Joint Arthroplasty”
Summary:
This is a retrospective study meaning it looks back patients that have already undergone care rather than a prospective study in which an experiment is designed and data is collected going forward. The investigators used a national database to review all patients who were diagnosed with COVID-19 over a two year period. They also identified all patients who underwent a total hip or total knee replacement during that timeframe. The researchers then matched patients undergoing total joint replacement during that time who had previously had COVID-19 with those who had not. Patents were paired by age, sex, health and other factors to ensure similar patients were compared.
They found that patient’s who had a diagnosis of COVID-19 before their joint replacement had a longer average stay in the hospital after surgery (1/2 day longer for knees, 1 day longer for hips). Patients with prior COVID-19 also had a higher rate of pneumonia after surgery. However, there was no difference in severe complications between the groups. This included no difference in risk of joint infection, kidney injury, cardiac arrest, blood clots, nerve injuries, pulmonary embolus, wound complications or need for blood transfusions.
The researchers concluded that patients with a history of COVID-19 could safely undergo total hip and knee replacement. Patients should be counselled that they may have a higher risk of pneumonia after surgery.
Dr. Horberg’s Thoughts:
All in all, this was a well designed study. While retrospective studies based on databases can be misleading because variables are not “controlled for” in advance by researchers and there can be limitations in the accuracy or completeness of the information input into the database, they do often provide large patient sample sizes.
There has been concern over whether patients who have recovered from COVID-19 carry higher risk of complication after surgery in general and joint replacement specifically. The biggest concerns seem to be pulmonary complications, blood clots or pulmonary emboli and cardiac complications. This study seems to suggest that patients who have recovered from COVID-19 are not at increased risk of serious complications after surgery. Patients with pre-existing lung issues should be informed that their risk of pneumonia after surgery is higher due to prior COVID-19 infection.
All in all, more research on this topic is needed. However, this study is reassuring for patients who have recovered from COVID-19 with arthritis pain in need of a joint replacement. While no surgery is without risk, prior COVID-19 infection does not seem to substantially increase the risk of joint replacement.
