Study: Surgeons should consider delaying TJA for at least 1 month after COVID-19 infection
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Key takeaways:
- COVID-19 infection within 1 month of TJA increased risk of deep vein thrombosis and venous thromboembolism.
- Surgeons may consider delaying TJA for at least 1 month following a COVID-19 infection in patients.
According to published results, patients who underwent total joint arthroplasty within 1 month of COVID-19 infection were at increased risk for postoperative thromboembolic events, such as deep vein thrombosis and venous thromboembolism.
Craig J. Della Valle, MD, and colleagues at Rush University Medical Center analyzed data from 31,453 patients who underwent total hip or knee arthroplasty between Jan. 1, 2018, and Oct. 31, 2020. Among the cohort, 2% of patients (n = 616) tested positive for COVID-19 before surgery.
Researchers compared 90-day complications between two final cohorts: a cohort of 281 patients who tested positive for COVID-19 within 3 months of surgery and a cohort of 281 matched patients who did not have COVID-19 within 3 months of surgery.
Overall, Della Valle and colleagues found patients who tested positive for COVID-19 within 1 month of TJA had an increased risk for postoperative deep vein thrombosis ( OR = 6.5) and venous thromboembolic events (OR = 8.32). They noted COVID-19 infection within 2 or 3 months of surgery did not significantly affect outcomes such as periprosthetic joint infection for patients in the matched cohorts.
“These results are important for orthopedic surgeons, as unfortunately, COVID-19 seems to be making a bit of a comeback as we have seen nationally and in our own practice,” Della Valle told Healio. “Ideally, prevention is optimal, and patients should strongly consider vaccination to prevent adverse events postoperatively. That being said, if a patient does become infected, elective arthroplasty procedures should be delayed by at least 1 month to reduce the risk of complications,” he said.
Perspective
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The results of this study are a reminder that caution should be exercised when considering total joint arthroplasty in patients who have recently recovered from COVID-19. Arthroplasty surgeons should consider discussing the potential increased risk of thromboembolic events with their patients. However, this study also raises several important questions.
First, data used in this study were collected in October 2020 and, as such, only captures the early stages of the COVID-19 pandemic. Since then, less-virulent strains of SARS-CoV-2 have replaced the dominant initial variants of the virus. These newer, less-virulent strains may affect postoperative venous thromboembolic risk to a lesser degree than the earlier, more lethal strains.
Second, the widespread administration of the COVID-19 vaccine, which significantly alters symptom severity, occurred long after the collection of data included in this study. Little is known about the postoperative risk for venous thromboembolic disease among vaccinated patients who contract COVID-19.
Lastly, symptom severity from a COVID-19 infection may also play a role in postoperative thromboembolic risk. Future research is needed to determine if patients with minimal symptoms are at lower risk than patients with severe symptoms or in patients with “long-COVID.”
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