TJA Outcomes in Immunocompromised Patients: A Matched-Pair Analysis - - PowerPoint PPT Presentation

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Sep 05, 2023 31 likes •162 views

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

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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

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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

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Material and Methods

850 Consecutive Total Joint Arthroplasties b/w 2008-2014, min. 2 yr follow-up

Hepatitis 122

HIV 32 31

665 Controls

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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

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Comorbidities

Diabetes
Smoking
Renal Disease
Asthma
Cardiac Conditions

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Negative Outcomes Definitions

Revision
Complication

– Prosthetic Joint Infection – Post-op Medical Complications – Neurovascular Complications

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Results in Study/Control Group 1

(Not Controlling for Comorbidities)

Results worse in the HIV/Hepatitis group

(P=0.0391, n=108)

Average Age Average BMI Number of Complications Number of Revisions Number of Smokers (Y/F) Number of Diabetes Control: 108 57.5 31.9 18 (16.7%) 3 (2.8%) 41/17 27 Study: 108 57.3 31.6 26 (24.07%) 11 (10.2%) 48/17 30

Complications Study Group- 24.1% Control Group- 16.7% Revisions Study Group- 10.2% Control Group 2.8%

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Results in Study/Control Group 2

(Controlling for Comorbidities)

Results are not statistically significant in the

immunocompromised group (P=0.2311, n=66)

Complications Study Group- 15.2% Control Group- 10.6% Revisions Study Group- 4.6% Control Group 1.5%

Average Age Average BMI Number of Complications Number of Revisions Number of Smokers (Y/F) Number of Diabetes Control: 66 56.682 30.3 7 (10.61%) 1 (1.52%) 24/14 12 Study: 66 56.981 30.8 10 (15.15%) 3 (4.55%) 32/9 12

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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…

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2017 JBJS Study Our Study Total Number of Patients 137,801 850 Number of Not Infected Patients 136,604 (99.13%) 665 (78.24%) Number of Hepatitis Monoinfected Patients 851 (0.62%) 122 (14.35%) Number of HIV Monoinfected Patients 278 (0.20%) 32 (3.76%) Number of HIV and Hepatitis Coinfected Patients 68 (0.05%) 31 (3.76%) Comorbidities Not Controlled For Controlled For Results Poorer Outcomes No Statistical Difference in Outcomes

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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.