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Primary immunodeficiency independently increases infectious, thromboembolic, renal, and pulmonary complications after total hip and knee arthroplasty, with a higher risk of periprosthetic joint infection and revision surgery.
Patients with primary immunodeficiency (PI) face noticeably higher infectious and medical complications after total knee arthroplasty (TKA) and total hip arthroplasty (THA), according to a large U.S. database study.
Jared Sasaki and other researchers conducted a retrospective cohort study using the PearlDiver Mariner database from 2010 to 2020, identifying patients who underwent primary THA or TKA using standardized current procedural terminology codes. Individuals with PI were identified through an extensive set of International Classification of Diseases (ICD)-9 and ICD-10 codes and matched 1:1 with non-PI patients based on osteoarthritis, age, gender, Charlson Comorbidity Index, obesity, tobacco usage, and alcohol abuse.
Post-surgery complications were examined at 90 days, 1 year, and 2 years. Multivariable logistic regression was utilized to check whether PI independently increased complication risk. Among patients undergoing THA, those with PI showed worse outcomes:
For TKA, PI was also linked to a broad spectrum of complications:
Despite a lower overall burden of metabolic comorbidities, PI patients experienced higher infectious and medical complications following surgery. The findings underscore the importance of developing PI-specific perioperative protocols, including enhanced infection prevention, closer postoperative surveillance, and tailored medical optimization strategies. Such approaches may improve clinical outcomes, decrease revision surgery, and minimize the economic burden linked with postoperative complications.
Journal of Orthopaedics
Primary immunodeficiency disorders increase the risk of postoperative complications following total hip and knee arthroplasty: A national matched cohort study
Jared Sasaki et al.
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