title: Does sickle cell disease increase risk of adverse outcomes following total hip and knee arthroplasty? A nationwide database study.
abstract: Sickle cell disease (SCD) is associated with impaired vascular function and progressive vaso-occlusive injury to bones. We used the Nationwide Inpatient Sample to identify all THA and TKA admissions between 1998 and 2010. After controlling for patient age, gender, insurance, race, and comorbidities, the risk of complication among admissions with SCD was 152% higher (P<0.001) for THA and 137% higher (P=0.001) for TKA. Patients with SCD had a length of stay that was 42% longer (P<0.001) for THA and 20% longer for TKA (P<0.001), and hospital charges that were 19% higher (P<0.001) for THA and 16% higher (P=0.001) for TKA. Orthopedic surgeons should counsel potential THA and TKA candidates with SCD of these risks prior to admission.
authors.affiliation: Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, New York; Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Dean C
authors.initials: DC
authors.lastname: Perfetti
authors.affiliation: Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, New York; Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Boylan
authors.affiliation: Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Qais
authors.initials: Q
authors.lastname: Naziri
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Harpal S
authors.initials: HS
authors.lastname: Khanuja
authors.affiliation: Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: William P
authors.initials: WP
authors.lastname: Urban
mesh_terms: D000328:Adult; D000368:Aged; D000755:Anemia, Sickle Cell / Q000150:complications*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000401:mortality; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000401:mortality; D001803:Blood Transfusion; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007592:Joint Diseases / Q000150:complications / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors
keywords: complication; cost; length of stay; sickle cell disease; total hip arthroplasty; total knee arthroplasty