The Impact of COVID-19 on Total Hip and Knee Arthroplasty: A Comprehensive Study

Recent research presented at the American Academy of Orthopaedic Surgeons Annual Meeting has shed light on the complications associated with patients who undergo total hip or knee arthroplasty within two weeks of a COVID-19 diagnosis. These patients were found to be at an increased risk for venous thromboembolism, sepsis, and surgical site infection. This study was based on data from the National COVID Cohort Collaborative, which categorized 110,186 patients into groups based on their COVID-19 diagnosis prior to surgery.

Understanding the Risk Profile

The study classified patients who were diagnosed with COVID-19 within 0 to 2 weeks and 2 to 6 weeks of undergoing total hip arthroplasty. These two groups showed similar complication profiles, including a heightened risk for venous thromboembolism, 30-day mortality, and 1-year mortality. On the other hand, patients who were diagnosed with COVID-19 within two weeks of undergoing total knee arthroplasty were shown to have an increased risk for sepsis and 30-day mortality.

The Long-Term Impact of COVID-19 on Surgery

The long-term impact of a COVID-19 diagnosis on patients who underwent surgery was also examined. It was observed that patients who underwent surgery 6 to 12 weeks after their COVID diagnosis showed an increased 1-year mortality rate. This indicates that the virus can have a lasting impact on the body, influencing post-surgery outcomes.

Avascular Necrosis and COVID-19

Another study conducted a systematic review of the correlation between time-limited high-dose corticosteroid administration in patients with severe COVID-19 infection and avascular necrosis. This review, encompassing a total of 245 patients from nine studies, found that corticosteroid administration might increase the incidence of avascular necrosis. However, the quality of recommendations is low due to a high risk of bias in the included studies.

The Role of Extended Oral Antibiotic Prophylaxis

Simultaneously, the efficacy of extended oral antibiotic prophylaxis (EOAP) in the prevention of periprosthetic joint infection after aseptic revision total hip arthroplasty was examined. No superficial or deep infections were observed at 30 and 90 days postoperatively when a 7-day postdischarge EOAP was used, suggesting that EOAP could potentially aid in the prevention of catastrophic periprosthetic joint infection with revision implants.

Technological Advancements and Infection Risk

It’s also important to note that advancements in surgical practices, such as the use of robotic-assisted surgery and surgical navigation techniques, were not associated with an increased risk of periprosthetic joint infection. A study analyzing the experience of nearly 13,000 patients undergoing primary total hip arthroplasty between 2018 and 2021 found that while these techniques were associated with slightly longer operative times, the incidence of infection was similar among groups.

These findings underline the need for further research to establish the optimal timeframe for undergoing total hip or knee arthroplasty with minimal postoperative complications after a COVID-19 diagnosis. As we continue to navigate the global pandemic, understanding the relationship between COVID-19 and surgical outcomes is crucial in ensuring the safety and wellbeing of patients.