Delay of total joint replacement is associated with a higher 90-day revision rate and increased postoperative complications

Abstract

Purpose Delay of elective surgeries, such as total joint replacement (TJR), is a common procedure in the current pandemic. In trauma surgery, postponement is associated with increased complication rates. This study aimed to evaluate the impact of postponement on surgical revision rates and postoperative complications after elective TJR. Methods In a retrospective analysis of 10,140 consecutive patients undergoing primary total hip replacement (THR) or total knee replacement (TKR) between 2011 and 2020, the effect of surgical delay on 90-day surgical revision rate, as well as internal and surgical complication rates, was investigated in a university high-volume arthroplasty center using the institute’s joint registry and data of the hospital administration. Moreover, multivariate logistic regression models were used to adjust for confounding variables. Results Two thousand four hundred and eighty TJRs patients were identified with a mean delay of 13.5 ± 29.6 days. Postponed TJR revealed a higher 90-day revision rate (7.1–4.5%, p < 0.001), surgical complications (3.2–1.9%, p < 0.001), internal complications (1.8–1.2% p < 0.041) and transfusion rate (2.6–1.8%, p < 0.023) than on-time TJR. Logistic regression analysis confirmed delay of TJRs as independent risk factor for 90-day revision rate [OR 1.42; 95% CI (1.18–1.72); p < 0.001] and surgical complication rates [OR 1.51; 95% CI (1.14–2.00); p = 0.04]. Conclusion Alike trauma surgery, delay in elective primary TJR correlates with higher revision and complication rates. Therefore, scheduling should be performed under consideration of the current COVID-19 pandemic. Level of evidence Level III—retrospective cohort study.

Analysis of the use of anesthetic blocks versus local anesthesia infiltration in primary total knee arthroplasty surgery.

“…Holzapfel DE et al [22] , describe an average age of 66.1 years (± 10.7), a BMI of 29 (± 5.5), their operative time in minutes is 76.2 (± 30.9) and the length of stay is 8.9 (± 3.0) days (higher than the average).…”

“…We have found differences in our study regarding the postoperative range of motion. Perhaps they could be attributed to the difference in volumes of analgesia administered (LIA or blocks), to the fact that the surgery was performed without ischemia [22] , or perhaps the prosthesis model also played a role. GMK Sphere is an innovative total knee implant designed to offer maximum functional stability with the goal of increasing patient satisfaction with total knee arthroplasty during activities of daily living and decreasing postoperative knee pain [34,35] .…”

Total Joint Arthroplasty in Patients Who Are Obese or Morbidly Obese

“…Outside the context of obesity, delayed TJA during the COVID-19 pandemic increased the pain that patients were experiencing and decreased function 39 . Delayed TJA may also increase complications and revisions 40 . Increased narcotic use, depression, and persistent ambulatory dysfunction are prevalent in patients deemed unfit for TJA 41,42 .…”