Sepsis Prior to Total Knee Arthroplasty is Associated With Elevated Rates of Myocardial Infarction and Deep Vein Thrombosis.

BACKGROUND: Patients who have sepsis often experience persistent physiological instability, which may increase vulnerability to postoperative complications. However, the impact of preoperative sepsis on outcomes following elective total knee arthroplasty (TKA) remains poorly defined. Thus, the purpose of this study was to investigate the association of preoperative sepsis with 90-day and two-year postoperative complications following TKA.

METHODS: A retrospective study was conducted utilizing an insurance database. Patients who had a preoperative diagnosis of sepsis within two years prior to TKA were matched 1:3 to controls based on demographics and comorbidities. Patients who had sepsis were stratified according to the following timeline: sepsis three months prior to surgery, three to six months prior, six to 12 months prior, 12 to 18 months prior, and 18 to 24 months prior. Medical and surgical complications were assessed at 90 days and two years following surgery. Statistical significance was set at P < 0.05.

RESULTS: Patients who had sepsis within two years prior to surgery exhibited increased rates of periprosthetic joint infection (PJI) (odds ratio (OR): 1.6), postoperative sepsis (OR: 2.7), acute kidney injury (OR: 1.4), urinary tract infection (OR: 1.8), blood transfusion (OR: 2.0), readmission (OR: 1.3), and wound dehiscence (OR: 1.4) within 90 days of surgery. At two years following surgery, sepsis was associated with elevated rates of revision surgery (OR: 1.3), PJI (OR: 1.6), osteomyelitis (OR: 1.9), and mortality (OR: 1.3). Sepsis within three months of operation was associated with elevated rates of myocardial infarction (OR: 2.1) and deep vein thrombosis (OR: 2.0). All findings were statistically significant at P < 0.05.

CONCLUSION: Preoperative sepsis is associated with increased complications following TKA, including periprosthetic joint infection and mortality. Sepsis within three months of surgery confers a particularly elevated risk of myocardial infarction and deep vein thrombosis following TKA.