TJA Outcomes in Immunocompromised Patients: A Matched-Pair Analysis Controlling for Comorbidity Grace Plassche, Ariel Silverman, Suhas Masilamani Abel Boenerjous, MD, Morteza Meftah, MD, Ira H. Kirschenbaum, MD
Background • HIV and Hepatitis are immunocompromising diseases that appear to negatively affect the results of total hip and knee arthroplasties • These results have been mixed in the literature • The impact of comorbidities has not been fully addressed
Material and Methods 850 Consecutive Total Joint Arthroplasties b/w 2008-2014, min. 2 yr follow-up Hepatitis HIV 31 122 32 665 Controls
Groups Analyzed Comorbidities • Study Group 1 – 108 HIV and/or Hepatitis patients – Matched 1:1 with controls • Sex, Age, BMI, & Procedure • Study Group 2 – 66 HIV and/or Hepatitis patients – Matched 1:1 with controls • Sex, Age, BMI, Procedure & Major Comorbidities
Comorbidities • Diabetes • Smoking • Renal Disease • Asthma • Cardiac Conditions
Negative Outcomes Definitions • Revision • Complication – Prosthetic Joint Infection – Post-op Medical Complications – Neurovascular Complications
Results in Study/Control Group 1 (Not Controlling for Comorbidities) • Results worse in the HIV/Hepatitis group (P=0.0391, n=108) Complications Revisions Study Group- 24.1% Study Group- 10.2% Control Group- 16.7% Control Group 2.8% Average Average Number of Number of Number of Number of Age BMI Complications Revisions Smokers (Y/F) Diabetes Control: 57.5 31.9 18 (16.7%) 3 (2.8%) 41/17 27 108 Study: 57.3 31.6 26 (24.07%) 11 (10.2%) 48/17 30 108
Results in Study/Control Group 2 (Controlling for Comorbidities) • Results are not statistically significant in the immunocompromised group (P=0.2311, n=66) Complications Revisions Study Group- 15.2% Study Group- 4.6% Control Group- 10.6% Control Group 1.5% Average Average Number of Number of Number of Number of Age BMI Complications Revisions Smokers (Y/F) Diabetes Control: 56.682 30.3 7 (10.61%) 1 (1.52%) 24/14 12 66 Study: 56.981 30.8 10 (15.15%) 3 (4.55%) 32/9 12 66
Study Specifics • This was a large single center study • Urban setting where patients all came from the same catchment area • While HIV and Hepatitis have been looked at separately, the role of comorbidities have not previously been fully appreciated • There is a wide range of comorbidities in this population • Differs from previous study…
2017 JBJS Study Our Study Total Number of 137,801 850 Patients Number of Not Infected 136,604 665 Patients ( 99.13% ) ( 78.24%) Number of Hepatitis 851 122 Monoinfected Patients ( 0.62% ) ( 14.35% ) Number of HIV 278 32 Monoinfected Patients ( 0.20%) ( 3.76%) Number of HIV and 68 31 Hepatitis Coinfected ( 0.05% ) ( 3.76% ) Patients Comorbidities Not Controlled For Controlled For Results Poorer Outcomes No Statistical Difference in Outcomes
Summary & Conclusions In our two phase study, what originally appeared to be a difference in outcomes in HIV/Hepatitis patients disappeared when we controlled for major comorbidities.
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