Elsevier

The Journal of Arthroplasty

Volume 31, Issue 12, December 2016, Pages 2746-2749
The Journal of Arthroplasty

Primary Arthroplasty
Patient-Reported Allergies Predict Worse Outcomes After Hip and Knee Arthroplasty: Results From a Prospective Cohort Study

https://doi.org/10.1016/j.arth.2016.07.040Get rights and content

Abstract

Background

Retrospective analyses have demonstrated correlation between patient-reported allergies and negative outcomes after total joint arthroplasty. We sought to validate these observations in a prospective cohort.

Methods

One hundred forty-four patients undergoing total hip arthroplasty and 302 patients undergoing total knee arthroplasty were prospectively enrolled. Preoperatively, patients listed their allergies and completed the Medical Outcomes Study Short Form 36 (SF-36) and the Charlson Comorbidity Index (CCI) Questionnaire. At a mean of 17 months (range 12-25 months) postoperatively, SF-36, CCI, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were obtained by telephone survey. Regression analysis was used to determine the strength of correlation between patient age, comorbidity burden, and number of allergies and outcome measurements.

Results

In 446 patients, 273 reported at least 1 allergy. The number of allergies reported ranged from 0 to 33. Penicillin or its derivative was the most frequently reported allergy followed by sulfa, environmental allergen, and narcotic pain medication. Patients reporting at least 1 allergy had a significantly lower postoperative SF-36 Physical Component Score compared to those reporting no allergies (51.3 vs 49.4, P = .01). The SF-36 postoperative Mental Component Score was no different between groups. Multivariate regression analysis showed that age and patient reported allergies, but not comorbidities, were independently associated with worse postoperative SF-36 Physical Component Summary (PCS) and WOMAC score. Patients with allergies experienced the same improvement in SF-36 PCS as those without an allergy. Comorbidities did not correlate with patient-reported function postoperatively.

Conclusion

Patients who report allergies have lower postoperative outcome scores but may experience the same increment in improvement after total joint arthroplasty.

Section snippets

Patients and Data Collection

Institutional Review Board approval was obtained for the study. Patients indicated for elective primary THA or TKA were enrolled prospectively into the study. Preoperatively, patients completed a general demographic form, which included age and general health status including self-reported allergies. These forms were filled out by patients upon enrolment in the study and were reviewed by a clinic nurse. Patients also completed the Charlson Comorbidity Index (CCI) Questionnaire [6] and the

Results

Of 452 patients enrolled in the study, complete data were available for 446. There was a predominance of female patients (66%) in the study, commensurate with previously published demographic data in total joint arthroplasty [11]. Total knee arthroplasty was performed for 68% of the patients. Surgeries were fairly evenly divided between right (49.5%) and left side. There was no difference in age, type of arthroplasty (THA or TKA), laterality, or follow-up time between patients who reported

Discussion

Total joint arthroplasty is one of the most efficacious modern surgical procedures performed. Patient satisfaction after surgery is generally high 2, 3, 12. Nevertheless, there remains a cohort of patients who are unhappy with the result of their surgery 1, 2. As we approach an era of quality-driven health care delivery, it is critical to identify predictors of patient dissatisfaction. Recent research has highlighted the importance of psychological factors in patient-reported outcomes after

References (19)

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    Other authors have reported similar findings15,19; however, in comparison to our study, which only considered medication and latex allergies, the aforementioned studies also included environmental,19 food,19 and contact allergies,10,15,24 in addition to other agents that were not explicitly defined.10,15,24 Nevertheless, latex and medication allergies accounted for the large majority of PRAs in each investigation.10,15,19,24 Although a definitive causal mechanism remains in question, the general consensus among authors who have investigated the impact of PRAs on orthopedic surgical outcomes and satisfaction is that PRAs may serve as a marker for underlying psychopathological comorbidity,10,15,19,24 which has been shown to have an association with worse PROs and patient satisfaction following both knee arthroplasty6 and shoulder arthroplasty.28,34

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    Thus, while there has not been an age limitation proven to predict success, we feel age should be considered when indicating a patient for SDD. Multiple studies have found associations between patient reported allergies and negative outcomes following TJA [27–30]. In this study, we found that patients who reported 2 or more allergies were at increased risk for failed SDD.

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    Interestingly, patients who made negative comments were more likely to have greater than 2 allergies. Previous studies have shown that increasing number of patient-reported allergies is significantly associated with worse outcomes after TJA [41–43]. A study of 459 TJA patients identified that patients who self-reported more than 4 allergies had worse PROM scores (SF-36 and WOMAC) than patients with 0-3 allergies [41].

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This work was supported by The Bierbaum Research Fund.

One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.07.040.

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