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Zhang Z, Yang H, Xu Z, Chi J, Cui Q. Total Hip Arthroplasty Outcomes in Patients with Gout: A Retrospective Analysis of Matched Large Cohorts. Clin Orthop Surg 2024; 16:542-549. [PMID: 39092306 PMCID: PMC11262945 DOI: 10.4055/cios24039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/02/2024] [Accepted: 03/07/2024] [Indexed: 08/04/2024] Open
Abstract
Background Gout is the most prevalent form of inflammatory arthritis in the world. Total hip arthroplasty (THA) has emerged as a widely sought-after and highly effective surgical procedure for advanced hip diseases. However, there is a lack of research on the impact of gout on primary THA outcomes in large cohorts. This study aimed to address this gap by primarily investigating complications following THA in patients with or without gout. Methods Patients with records of gout in the 2 years leading up to their primary THA and who also have at least 2 years of follow-up were identified using a national insurance database and compared to a 5:1 matched control. A total of 32,466 patients with gout and 161,514 patients without gout undergoing THA were identified. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to 2 years. In addition, 90-day emergency department (ED) visits and inpatient readmission were also documented. Results Patients with gout demonstrated higher rates of medical complications including deep vein thrombosis, transfusion, acute kidney injury, and urinary tract infection than non-gout patients (p < 0.001). Gout patients also showed higher rates of pulmonary embolism (p = 0.017). Increased incidences of surgical complications were identified in gout patients, specifically wound complications and periprosthetic joint infection (p < 0.001). There was an increased risk of revision for gout patients up to 90 days (p = 0.003), 1 year (p = 0.027), and 2 years (p = 0.039). There was also an increased risk of dislocation for gout patients up to 90 days (p = 0.022) and 1 year (p = 0.047), but not at 2 years. No significant difference was observed in aseptic loosening or periprosthetic fracture. Additionally, gout patients also demonstrated a higher likelihood of 90-day ED visits and readmission (p < 0.001). Conclusions Primary THA in gout patients is associated with increased risks of multiple medical and surgical complications. Our findings provide insights into the planning and expectation of THA for patients with gout. These insights have the potential to benefit the decision-making process for gout patients considering THA.
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Affiliation(s)
- Zhichang Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Hanzhi Yang
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Zhiwen Xu
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
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Fox JA, Domingue GA, DeMaio CV, Brockman BS, Malloy K, Thakral R. Total hip arthroplasty complications in patients with chronic kidney disease: A comparison study. J Orthop 2023; 39:1-6. [PMID: 37077839 PMCID: PMC10106339 DOI: 10.1016/j.jor.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/24/2023] [Accepted: 03/29/2023] [Indexed: 04/21/2023] Open
Abstract
Background It has been noted in the literature that there are increased complication rates following total hip arthroplasty (THA) in patients with chronic kidney disease (CKD) or end stage renal disease (ESRD). However, there is little data directly comparing outcomes in patients undergoing THA for osteoarthritis (OA) versus ESRD or CKD with OA. The objective of this study is to illustrate the risk of developing postoperative complications after THA in the CKD and ESRD populations by stage of disease when compared to a control group (OA) and thus better equip orthopaedic providers in the care of these patients. Methods The National Inpatient Sample (NIS) was utilized to identify patients undergoing elective THA from 2006 to 2015 with OA, ESRD, and CKD. The prevalence of preoperative comorbidities and the incidence of numerous postoperative complications broken into categories were examined. Results Between 2006 and 2015 the NIS database reported 4,350,961 patients diagnosed with OA, 8355 diagnosed with ESRD, and 104,313 diagnosed with CKD undergoing THA. The incidence of wound hematoma (2.5% vs. 0.8%; p < .0001), wound infection (0.7% vs. 0.4%; p = .0319), cardiac (1.3% vs. 0.6%; p = .0067), urinary (3.9% vs. 2.0%; p < .0001), and pulmonary complications (2.2% vs. 0.5%; p < .0001) occurred more frequently in patients with OA and ESRD when compared to only OA patients. For patients with OA and CKD, stages 3-5 saw at least half of the complication categories occur at significantly higher rates than OA patients. Conclusion This study shows that patients with ESRD and CKD have increased rates of complications after THA. This study's specific breakdown by stage and complication can benefit orthopaedic surgeons and practitioners in realistic pre and postoperative planning and provides data that could benefit decision making on bundled reimbursement for this specific patient population, as providers could better account for the postoperative complications noted above and their associated costs.
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Affiliation(s)
- Jake A. Fox
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Grayson A. Domingue
- University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Oklahoma City, OK 73104, USA
| | - Christian V. DeMaio
- University of Oklahoma College of Medicine, 940 Stanton L Young Blvd, Oklahoma City, OK 73104, USA
| | - Bryan S. Brockman
- Baptist Health South Florida, 6855 Red Rd Ste 500, Coral Gables, Florida 33143, USA
| | - Kimberly Malloy
- University of Oklahoma College of Public Health, 801 NE 13th St, Oklahoma City, OK, 73104 USA
| | - Rishi Thakral
- University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Oklahoma City, OK 73104, USA
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Cohen-Rosenblum AR, Somogyi JR, Hynes KK, Guevara ME. Orthopaedic Management of Gout. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e22.00216. [PMID: 36346841 PMCID: PMC9645791 DOI: 10.5435/jaaosglobal-d-22-00216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/14/2022] [Indexed: 10/27/2023]
Abstract
Gout is characterized by the deposition of monosodium urate crystals in patients with chronically elevated blood levels of uric acid. It is the most common form of inflammatory arthritis in the United States and is often comorbid with hypertension, obesity, and chronic kidney disease. Initial presentation is usually an acutely warm, swollen joint, most commonly the first metatarsophalangeal joint, but a variety of locations may be affected. The main treatment for gout is medical management of acute inflammation and chronic uric acid levels, but surgical treatment may be indicated in cases of damage to the surrounding soft tissue, concomitant septic arthritis, symptomatic cartilage loss, or neurologic deficits. Based on the literature to date, gout does not seem to independently affect outcomes after total hip, knee, and ankle arthroplasty, but associated comorbidities affecting outcomes in these patients should be considered.
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Affiliation(s)
- Anna R. Cohen-Rosenblum
- From the Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Cohen-Rosenblum); the Texas Orthopedics; Affiliate Faculty, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas, Austin, TX (Dr. Somogyi); the Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Medicine, Chicago, IL (Dr. Hynes); and the Department of Medicine, Section of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Guevara)
| | - Jason R. Somogyi
- From the Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Cohen-Rosenblum); the Texas Orthopedics; Affiliate Faculty, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas, Austin, TX (Dr. Somogyi); the Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Medicine, Chicago, IL (Dr. Hynes); and the Department of Medicine, Section of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Guevara)
| | - Kelly K. Hynes
- From the Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Cohen-Rosenblum); the Texas Orthopedics; Affiliate Faculty, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas, Austin, TX (Dr. Somogyi); the Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Medicine, Chicago, IL (Dr. Hynes); and the Department of Medicine, Section of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Guevara)
| | - Myriam E. Guevara
- From the Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Cohen-Rosenblum); the Texas Orthopedics; Affiliate Faculty, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas, Austin, TX (Dr. Somogyi); the Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Medicine, Chicago, IL (Dr. Hynes); and the Department of Medicine, Section of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Guevara)
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