Increased rate of complications in myasthenia gravis patients following hip and knee arthroplasty: a nationwide database study in the PearlDiver Database on 257,707 patients

Abstract

Background and purpose — The increasing prevalence of total hip arthroplasty (THA) and total knee arthroplasty (TKA) within the growing elderly population is translating into a larger number of patients with neuromuscular conditions such as myasthenia gravis (MG) receiving arthroplasty. We compared systemic and joint complications following a THA or TKA between patients with MG and patients without MG. Patients and methods — Patient records were queried from PearlDiver (Pearl Diver Inc, Fort Wayne, IN, USA), an administrative claims database, using ICD-9/ICD-10 and Current Procedural Terminology codes. In-hospital and 90-day post-discharge rates of systemic and joint complications were compared between the 2 cohorts. Results — 372 patients with MG and 249,428 patients without MG who received a THA or TKA were included in the study. At 90 days post-discharge, MG patients exhibited exhibited between 1.6 and 15% higher rates of systemic complications, including cerebrovascular event, pneumonia, respiratory failure, sepsis, myocardial infarction, acute renal failure, anemia, and deep vein thrombosis (all p < 0.001). The same results were also found during the in-hospital time period. 90-day incidence of aseptic loosening was the only joint complication with significantly increased odds risk for the MG cohort (OR 5; 95% CI 2–12). Interpretation — Patients with MG exhibited significantly higher risk for multiple systemic complications during the index hospital stay and in the acute post-discharge setting.

Myasthenia Gravis and Abdominal Aortic Aneurysm: A Rare Combination

“…MG is an autoimmune disorder that targets the neuromuscular junction, characterized by fluctuating fatigue and weakness, initially affecting the extraocular muscles but with frequent generalization encompassing bulbar and respiratory musculature 1 . AChR antibodies (Abs), which were present in our patient, are highly specific in confirming the diagnosis 2 .…”

“…The general risk was 1.6 to 15% higher after hip and knee arthroplasty, while AMI had an odds ratio: 7.4 during hospitalization in a recent report. 1 Surprisingly, the widespread use of preoperative stress testing in many centers did not reduce perioperative major adverse cardiovascular events. 5 …”

Risk for recurrent instability and reoperation following arthroscopic and open shoulder stabilization in a large cross-sectional population

“… 28 , 29 It has been used in prior population-scale analyses both in shoulder instability analysis and other orthopedic surgery procedures. 12 , 18 , 20 , 29 …”