Total Joint Arthroplasty in Immunocompromised Patients

A Matched Pair Analysis for Comorbidities

Morteza Meftah, MD; Grace Plassche, BS; Ariel Silverman, BS; Peter B. White, BS; Ira H. Kirschenbaum, MD


Curr Orthop Pract. 2019;30(3):246-249. 

In This Article

Materials and Methods

A retrospective review of our institutional review board-approved database was performed to identify all TJAs performed between 2008 and 2014. Eight hundred and fifty total joint arthroplasties (TJA) were identified during this period with a minimum 2-year follow up. A sample size analysis showed that 100 patients were required in each group for a matched pair analysis to detect 10% difference with 80% power (alpha 0.2). Using this cohort, all patients with a history of HIV and HCV were identified. One hundred and nine TJAs (n=50 THAs and n=59 TKAs) were identified. These patients were then matched in a one-to-one fashion with 107 immunocompetent patients (no history of HIV or HCV) based on age, sex, body mass index (BMI), and operation (TKA vs. THA). This included a cohort of 66 patients who were matched based on medical comorbidities including asthma, cardiac disease, renal disease, smoking, and diabetes.[22] The mean age in the immunocompromised (IC) and nonimmunocompromised (N-IC) groups was 57±8.6 years and 57.2±8.5 years, respectively (Table 1). There was no statistically significant difference for age, gender, BMI, or procedure type between the two cohorts (Table 1).

The primary outcome of the study was the incidence of overall complications including periprosthetic joint infection (PJI), superficial wound infection, postoperative medical complications (i.e. pneumonia, urinary tract infection, acute kidney injury, etc) during the study period. PJI was defined per Musculoskeletal Infection Society guidelines.[23]

Secondary outcomes evaluated included the incidence of readmissions, reoperations, and revision surgeries, as well as assessment of correlation between adverse outcomes and other comorbidities. In-patient medical records were used to evaluate medical comorbidities and risk factors, including obesity, diabetes, smoking, cardiopulmonary disease, hypertension, and substance abuse. All TJAs were performed by the two-fellowship-trained senior authors (M.M. and I.H.K.), using similar techniques and implants (Stryker Accolade and Triathlon system, Mahwah, NJ, USA).

Statistics were performed on STAT 14.0 (College Station, TX, USA) with chi-squared and t-tests for categorical and continuous variables, respectively. Descriptive statistics are displayed as means continuous variables and frequencies with percentages for categorical variables. A multivariate logistic regression was also performed to identify the effects of co-moboridities on perioperative complications, readmission, and infection rates. Descriptive statistics for the regression include odds ratios with 95% confidence intervals.