From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Mr. Smith-Voudouris, Dhodapkar, Halperin, and Dr. Grauer); the Department of Dermatology, Yale School of Medicine, New Haven, CT (Dr. Cohen); and the Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT (Dr. Cohen).
J Am Acad Orthop Surg Glob Res Rev. 2024 Oct 21;8(10). doi: 10.5435/JAAOSGlobal-D-23-00267. eCollection 2024 Oct 1.
Atopic dermatitis (AD), also known as eczema, is a highly prevalent, chronic inflammatory skin condition. The perioperative outcomes of patients with AD after total knee arthroplasty (TKA) have not been characterized.
Adult patients who underwent TKA were identified in the PearlDiver administrative database. After matching based on patient characteristics, 90-day adverse events and 5-year revisions were compared by multivariable analyses and log-rank tests, respectively. Patients with atopic dermatitis were then stratified by medication status for repeated analysis between resultant subcohorts.
Relative to age, sex, and comorbidity matched patients without AD, those with AD had increased odds of aggregated adverse events (OR = 1.36), pneumonia (OR = 2.07), urinary tract infection (UTI, OR = 1.77), and emergency department (ED) visits (OR = 1.70) (P < 0.0001 for each). Those on medication for moderate-to-severe disease had similar associations as the primary analysis. Those not on medications were similar, but not found to have elevated odds of pneumonia. 5-year revisions were not markedly different.
TKA patients with AD were at increased odds of pneumonia, UTI, and ED visits, but these risks were not exacerbated by immunosuppressive medications. Surgeons who are managing patients with AD for TKA should be vigilant but reassured by overall similar 5-year survival to revision.
特应性皮炎（AD），又称湿疹，是一种高发的慢性炎症性皮肤病。特应性皮炎患者行全膝关节置换术（TKA）后的围手术期结局尚未明确。
在 PearlDiver 行政数据库中确定接受 TKA 的成年患者。在基于患者特征进行匹配后，通过多变量分析和对数秩检验分别比较了 90 天不良事件和 5 年翻修率。然后，根据药物治疗情况将特应性皮炎患者分层，在所得亚组之间进行重复分析。
与无 AD 的年龄、性别和合并症匹配患者相比，AD 患者的不良事件总发生率（OR = 1.36）、肺炎（OR = 2.07）、尿路感染（UTI，OR = 1.77）和急诊就诊（ED，OR = 1.70）的几率更高（每种情况 P < 0.0001）。中重度疾病用药患者的相关性与主要分析一致。未用药患者的相关性相似，但未发现肺炎风险升高。5 年翻修率无明显差异。
AD 患者行 TKA 后发生肺炎、UTI 和 ED 就诊的几率增加，但免疫抑制药物并未加剧这些风险。管理 TKA 中 AD 患者的外科医生应保持警惕，但总体上与翻修相比，5 年生存率相似，这可使他们感到安心。
