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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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Pandya RP, Ganesan V, Rodriguez AN, Magruder ML, Wong CHJ, Choueka J, Razi AE. Crohn's disease is associated with higher rates of implant-related complications following primary total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1357-1362. [PMID: 38150021 DOI: 10.1007/s00590-023-03794-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/16/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION In Western countries, there has been a rise in the prevalence of Crohn's Disease (CD) and primary total knee arthroplasty (TKA). This study delves deeper into the effects of CD on TKA patients by examining (1) the length of in-hospital stay (LOS); (2) the rates of readmission; (3) complications related to implants; and (4) the costs associated with care. METHODS A retrospective analysis using the PearlDiver database was conducted, encompassing the time frame between January 1st, 2005 and March 31st, 2014, focusing on patients who underwent TKA and were either diagnosed with CD or not. Patients with CD were paired with control subjects at a 1:5 ratio based on age, gender, and medical comorbidities. The analysis comprised a total of 96,229 patients (CD = 16,039; non-CD = 80,190). RESULTS Patients with CD had a notably longer hospital stay (3 v. 2 days, p < 0.0001) and faced significantly higher rates of 90-day readmissions and complications (19.80% v. 14.91%, OR: 1.40, p < 0.0001; 6.88% v. 4.88%, OR: 1.43, p < 0.0001 respectively). Additionally, CD patients incurred greater expenses on the surgery day ($18,365.98 v. $16,192.00) and within 90 days post-surgery ($21,337.46 v. $19,101.42). CONCLUSION This study demonstrates longer in-hospital LOS, higher rates of readmissions, implant-related complications, and costs of care among CD patients following primary TKA.
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Affiliation(s)
- Radha P Pandya
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49Th St., Brooklyn, NY, 11219, USA
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Vanathi Ganesan
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49Th St., Brooklyn, NY, 11219, USA
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Ariel N Rodriguez
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49Th St., Brooklyn, NY, 11219, USA.
| | - Matthew L Magruder
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49Th St., Brooklyn, NY, 11219, USA
| | - Che Hang Jason Wong
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49Th St., Brooklyn, NY, 11219, USA
| | - Jack Choueka
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49Th St., Brooklyn, NY, 11219, USA
| | - Afshin E Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49Th St., Brooklyn, NY, 11219, USA
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Huffman N, Pasqualini I, Surace P, Molloy RM, Piuzzi NS, Deren ME. Diagnosis, Treatment, and Outcomes of Crystalline Arthropathy in the Setting of Total Knee Arthroplasty: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202312000-00010. [PMID: 38134288 DOI: 10.2106/jbjs.rvw.23.00163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
» Emerging evidence suggests the prevalence of crystalline arthropathy (CA) in the setting of total knee arthroplasty (TKA) is increasing, and diagnosis of CA is often intricate because of symptom overlap with other common postoperative complications such as periprosthetic joint infection (PJI). Consequently, an accurate and timely diagnosis becomes pivotal in guiding the choice of treatment.» CA includes gout and calcium pyrophosphate deposition (CPPD) disease, and accurate diagnosis in patients with prior TKA requires a multifaceted approach. The diagnosis algorithm plays a critical role in determining the appropriate treatment approach.» Management of CA typically involves a conservative strategy, encompassing the administration of nonsteroidal anti-inflammatory drugs, colchicine, and steroids, regardless of whether patients have undergone prior TKA.» There is conflicting evidence on the effect CA has on the surgical outcomes in postoperative TKA patients. While these patients may expect excellent functional outcomes and pain relief, they may be at a higher risk of complications such as infections, medical complications, and revision procedures.» Additional research is required to fully comprehend the impact of CA on postoperative TKA outcomes and to establish effective strategies for enhancing patient care and optimizing long-term joint function.
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Affiliation(s)
- Nickelas Huffman
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Peter Surace
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert M Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Matthew E Deren
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Pandya S, Melville DM. Evaluation of the knee joint with ultrasound and magnetic resonance imaging. J Ultrason 2023; 23:e239-e250. [PMID: 38020509 PMCID: PMC10668946 DOI: 10.15557/jou.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/21/2023] [Indexed: 12/01/2023] Open
Abstract
The knee joint relies on a combination of deep and superficial structures for stability and function. Both ultrasound and high-resolution magnetic resonance imaging are extremely useful in evaluating these structures and associated pathology. This article reviews a combination of critical anatomic structures, joint abnormalities, and pathologic conditions at the knee joint, while highlighting the merits, limitations, and pitfalls of the two imaging modalities. A clear appreciation of each method paired with its relative strengths will aid in expediting diagnosis and appropriate treatment for a wide range of knee joint conditions.
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Affiliation(s)
- Siddharth Pandya
- Department of Radiology, Valleywise Health Medical Center, Phoenix, USA
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The Effects of Gout Following total Knee Arthroplasty: A Retrospective Analysis. J Arthroplasty 2023:S0883-5403(23)00083-9. [PMID: 36764406 DOI: 10.1016/j.arth.2023.01.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The prevalence of gout is increasing along with the number of total knee arthroplasties (TKA) performed annually. The purpose of this study was to evaluate the incidence of gout following TKA in patients who had a previous history of gout and to determine if it is associated with an increased rate of postoperative joint complications. METHODS Patients who did and did not have a preoperative diagnosis of gout and underwent a primary TKA were identified from a national database. The gout patients were matched 1:1 to patients who did not have gout and rates of postoperative gout diagnoses within 2 years of surgery were compared. Complication rates at mean 1 and 2 years were then compared for both patient cohorts using multivariable logistic regressions. A total of 17,463 patients with a prior diagnosis of gout were matched with 17,463 controls. RESULTS There were 53.8% of patients who had previous gout and had a recurrence of gout within 2 years versus 3.6% of controls (Odds Ratios [OR]: 30.86). At mean 1-year, patients who had gout were significantly more likely to experience prosthetic joint infections (PJIs) and revision procedures. At mean 2 years, gout patients were at increased risk of prosthetic loosening, PJI, revision, and incision and debridement procedures. CONCLUSION This study suggests that patients who had a prior diagnosis of gout are significantly more likely to experience recurrent episodes of gout after TKA. Gout attacks after TKA are associated with an increase in the rate of joint complications. LEVEL OF EVIDENCE Level III.
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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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