Higher Complication Rate in COVID-19 Recovered Patients Undergoing Primary Total Joint Arthroplasty.

BACKGROUND: There is limited data reviewing complication risks associated with total joint arthroplasty (TJA) after recovering from COVID-19. This study evaluated complications within 90 days of TJA in patients who had a COVID-19 diagnosis at varying intervals prior to surgery vs a non-COVID-19 cohort. METHODS: A large national database was used to identify patients diagnosed with COVID-19 in the six months prior to total hip arthroplasty (THA) or total knee arthroplasty (TKA). The incidence of complications within 90 days of surgery was recorded and compared to a COVID-19 negative control group matched 1:3 for age range in 5-year intervals, Charlson Comorbidity Index, and sex. There were 7,780 patients included in the study; 5,840 (75.1%) never diagnosed with COVID-19, 1,390 (17.9%) who had a COVID-19 diagnosis 0 to 3 months prior to surgery, and 550 (7.1%) who had a COVID-19 diagnosis 3 to 6 months prior to surgery. RESULTS: When compared to their COVID negative controls, patients who had a COVID-19 diagnosis 0 to 3 months prior to surgery had significantly higher rates of re-admission (14.0 vs 11.1%, P=.001), pneumonia (2.2 vs 0.7%, P<.001), deep vein thrombosis (3.3 vs 1.9%, P=.001), kidney failure (2.4 vs 1.4%, P=.006), and acute respiratory distress syndrome (1.4 vs 0.7%, P=.01). Patients who had a COVID-19 diagnosis 3 to 6 months prior to surgery had significantly higher rates of pneumonia (2.0 vs 0.7%, P=.002) and deep vein thrombosis (3.6 vs 1.9%, P=.005) when compared to their COVID negative controls. CONCLUSION: Patients diagnosed with COVID-19 within three months prior to TJA have an increased risk of 90-day postoperative complications. Risk for pneumonia and deep vein thrombosis remains elevated even when surgery was performed as far as 3 to 6 months after COVID-19 diagnosis.