Gudmundsson Paul, Gadda Marc, Areti Aruni, Sambandam Senthil
UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
Baylor College of Medicine, 1 Baylor Plz, Houston, TX 77030, USA.
J Clin Med. 2024 Nov 25;13(23):7116. doi: 10.3390/jcm13237116.
This study investigated the impact of recent syphilis infection on postoperative outcomes following total knee arthroplasty (TKA). We hypothesized that patients with a documented history of syphilis infection would experience a higher rate of postoperative complications compared to those without such a history. We conducted a retrospective cohort analysis using a national insurance claims database. Our study population included 237,360 patients who underwent primary TKA between 2005 and 2024. Patients were classified into two groups based on the presence (+Syph) or absence (-Syph) of a syphilis diagnosis within one year prior to the TKA. We evaluated the rates of several postoperative complications at 30 days postsurgery, including infection, hematologic issues, and cardiac events. Statistical analyses between groups was performed using chi-squared tests and Fisher's exact tests. Routine demographic data such as age, sex, race, and comorbidities were also analyzed. Among the 237,360 TKA patients, we identified 71 with a history of syphilis within one year of their surgery. The +Syph group exhibited significantly higher rates of periprosthetic infection (4.23% vs. 0.81%, = 0.001), need for manipulation under anesthesia (MUA) at four months (7.04% vs. 2.82%, = 0.032), deep venous thrombosis (4.23% vs. 1.27%, = 0.026), periprosthetic fracture (2.82% vs. 0.23%, < 0.001), and pneumonia (2.82% vs. 0.62%, = 0.019) within 30 days postTKA. No significant differences were observed in 30-day mortality, deep or superficial surgical site infections, wound dehiscence, blood loss anemia, or transfusion requirements. Additionally, rates of acute renal failure, pulmonary embolism, and cardiac events did not differ significantly between groups. Demographically, patients in the syphilis cohort had a higher prevalence of smoking and diabetes preoperatively within one year of their surgical date. A documented syphilis diagnosis within one year of TKA significantly affects postoperative outcomes, increasing the rates of prosthetic joint infection, MUA, deep venous thrombosis, periprosthetic fracture, and pneumonia. These findings underscore the need for heightened vigilance in the pre- and postoperative management of patients with a history of syphilis infection undergoing TKA. Further research is warranted to explore the relationship between prior syphilis infection and TKA outcomes, as well as to develop strategies to mitigate this increased risk.
本研究调查了近期梅毒感染对全膝关节置换术（TKA）术后结果的影响。我们假设，有梅毒感染记录史的患者与没有此类病史的患者相比，术后并发症发生率更高。我们使用国家保险理赔数据库进行了一项回顾性队列分析。我们的研究人群包括2005年至2024年间接受初次TKA的237,360名患者。根据TKA术前一年内是否存在梅毒诊断（+Syph）或不存在（-Syph）将患者分为两组。我们评估了术后30天内几种术后并发症的发生率，包括感染、血液学问题和心脏事件。组间统计分析采用卡方检验和Fisher精确检验。还分析了年龄、性别、种族和合并症等常规人口统计学数据。在237,360名TKA患者中，我们确定了71名在手术一年内有梅毒病史的患者。+Syph组在TKA术后30天内假体周围感染率（4.23%对0.81%，P = 0.001）、四个月时麻醉下手法操作（MUA）需求率（7.04%对2.82%，P = 0.032）、深静脉血栓形成率（4.23%对1.27%，P = 0.026）、假体周围骨折率（2.82%对0.23%，P < 0.001）和肺炎发生率（2.82%对0.62%，P = 0.019）显著更高。在30天死亡率、深部或浅部手术部位感染、伤口裂开、失血贫血或输血需求方面未观察到显著差异。此外，急性肾衰竭、肺栓塞和心脏事件的发生率在两组之间也没有显著差异。在人口统计学上，梅毒队列中的患者在手术日期前一年内术前吸烟和糖尿病的患病率更高。TKA术前一年内有记录的梅毒诊断会显著影响术后结果，增加假体关节感染、MUA、深静脉血栓形成、假体周围骨折和肺炎的发生率。这些发现强调了对有梅毒感染史且接受TKA的患者在术前和术后管理中需要提高警惕。有必要进一步研究探索既往梅毒感染与TKA结果之间的关系，以及制定策略来降低这种增加的风险。
