BACKGROUND
Total knee arthroplasty (TKA) is a highly successful procedure for managing arthritis, though complications such as periprosthetic joint infection (PJI), periprosthetic fracture (PPFx), and mechanical loosening can occur. Psoriasis has been associated with an increased likelihood of requiring TKA.
METHODS
A large, multi-institutional electronic health records database was utilized to identify patients who had an active diagnosis of psoriasis within three months prior to undergoing TKA. Using propensity-score matching, these patients were matched 1:1 with a cohort of patients who did not have psoriasis prior to TKA. Outcomes assessed at 90-days postoperatively included wound disruption, infection, pulmonary embolism, deep vein thrombosis (DVT) of the lower extremity, acute kidney injury (AKI), and readmissions. The two-year outcomes included PPFx, PJI, mechanical loosening, and revision total knee arthroplasty (rTKA). A total of 156,015 patients undergoing primary TKA were identified. Ultimately, 4,191 patients who had psoriasis were propensity matched to 4,191 controls.
RESULTS
Patients who had psoriasis were at a greater risk of developing DVT (RR [relative risk]: 1.5; CI [confidence interval]: 1.1 to 2.0) and wound disruption (RR: 1.7; CI: 1.1 to 2.6) at 90 days postoperatively. At two years postoperatively, patients who had psoriasis had higher rates of PJI (RR: 1.5; CI: 1.1 to 2.1) and rTKA (RR: 1.5, CI: 1.1 to 2.0).
CONCLUSIONS
Patients who have psoriasis undergoing TKA have a higher risk of wound disruption and DVT of the lower extremity within 90 days, and of PJI and rTKA within two years. The elevated risk of these complications warrants particular attention from orthopaedic surgeons and their patients who have psoriasis in both preoperative shared decision-making and close follow-up care.
Tarun R. Sontam, Sri Tummala, Jack Janett et al.· Journal of Arthroplasty· 0 citations
BACKGROUND
Total hip arthroplasty (THA) is commonly performed in older adults who have coexisting aortic stenosis (AS), a condition associated with fixed cardiac output and limited hemodynamic reserve. This study assessed 30-day complications and the impact of day-of-surgery medications in patients who have AS undergoing THA.
METHODS
A retrospective cohort study using a national database identified adults undergoing THA from January 2006 to January 2026. Individuals who had AS were propensity score-matched 1:1 to those who did not have AS, and 30-day complications were compared using risk ratios. After propensity score matching, 7,582 patients remained in each cohort. The 30-day outcomes were also compared between AS patients who received day-of-surgery tranexamic acid (TXA) and matched patients who did not. Cox regressions evaluated associations between day-of-surgery medications and 30-day stroke risk within the AS cohort.
RESULTS
Compared with matched controls, patients who had AS experienced significantly higher rates of 30-day complications following THA, particularly cardiovascular complications such as stroke and myocardial infarction (both P < 0.05). Aortic stenosis was also associated with increased risks of bacteremia, pneumonia, transfusion, acute renal failure, acute posthemorrhagic anemia, intensive care unit (ICU) care, and readmission (all P < 0.05). Among patients who had AS, day-of-surgery TXA use was associated with lower rates of 30-day transfusion, periprosthetic joint infection, ICU care, and readmission (all P < 0.05), without significant differences in cardiovascular or thromboembolic complications. Within the AS cohort, day-of-surgery thiazide diuretics, angiotensin-converting enzyme inhibitors, and beta blockers were independently associated with increased 30-day stroke hazard (all P < 0.05), whereas other evaluated day-of-surgery cardiovascular medication classes were not significantly associated with increased stroke risk.
CONCLUSION
Patients who have AS undergoing THA face elevated risks of early complications, particularly stroke and systemic events. Careful perioperative hemodynamic optimization and cardiovascular medication management may help mitigate 30-day morbidity.
James Hwang, Robert Wei, Angel A. Valencia et al.· Journal of Arthroplasty· 0 citations
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