Kenneally Hannah, Brown Nicholas, Schmitt Daniel
Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
Department of Orthopedic Surgery, Loyola University Chicago Health Sciences Division, Maywood, IL, USA.
Arthroplast Today. 2023 Oct 14;24:101220. doi: 10.1016/j.artd.2023.101220. eCollection 2023 Dec.
Ostomy surgery is associated with a high rate of postoperative complications and poses several theoretical concerns for subsequent total joint arthroplasty (TJA). There is concern that ostomy may negatively impact nutrition or increase risk of known gastrointestinal (GI) complications such as obstruction, constipation, or diarrhea, particularly with the use of postoperative opioids. There is also concern that the open nature of the ostomy may increase the risk of infection. This case series reports outcomes and assesses the risk associated with TJA in patients with previous surgical history of intestinal ostomy.
This is an institutional review board-approved retrospective case series of patients with surgical history of ostomy who underwent total hip or total knee arthroplasty. Cohort consisted of 14 cases in 10 patients and was examined to report individual TJA and ostomy procedural details and outcomes.
Of the 14 cases, none required GI clearance or prophylaxis outside of standard perioperative antibiotics prior to TJA surgeries, and all TJAs resulted in good outcomes. Four cases (29%) had a complication, although only 2 of these were GI complications and none were life-threatening or required further surgery. The first of the 2 experienced increased ostomy output, and symptoms were resolved promptly with rehydration. The second experienced decreased ostomy output, and symptoms were resolved promptly with changes in prn pain medications. Other complications were postoperative urinary tract infection and syncopal episode.
TJA can be performed safely in the setting of ostomy with major consideration being risk of diarrhea or constipation during postoperative period.
造口术与术后并发症的高发生率相关，并且对随后的全关节置换术（TJA）存在一些理论上的担忧。有人担心造口术可能对营养产生负面影响，或增加已知的胃肠道（GI）并发症的风险，如梗阻、便秘或腹泻，特别是在使用术后阿片类药物的情况下。还有人担心造口术的开放性可能会增加感染风险。本病例系列报告了结果，并评估了既往有肠道造口手术史的患者进行TJA的相关风险。
这是一项经机构审查委员会批准的回顾性病例系列研究，研究对象为有造口手术史且接受了全髋关节或全膝关节置换术的患者。队列由10名患者中的14例组成，对其进行检查以报告个体TJA和造口手术的详细过程及结果。
在这14例病例中，在TJA手术前，除了标准的围手术期抗生素外，没有一例需要进行胃肠道清理或预防，并且所有TJA均取得了良好的结果。4例（29%）出现了并发症，不过其中只有2例是胃肠道并发症，且均未危及生命或需要进一步手术。2例中的第一例造口排出量增加，通过补液症状迅速得到缓解。第二例造口排出量减少，通过调整按需使用的止痛药物症状迅速得到缓解。其他并发症为术后尿路感染和晕厥发作。
在有造口的情况下可以安全地进行TJA，主要考虑的是术后腹泻或便秘的风险。
