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



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.



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.



Patients who report allergies have lower postoperative outcome scores but may experience the same increment in improvement after total joint arthroplasty.
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Jesse E
JE
Otero
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Christopher M
CM
Graves
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Yubo
Y
Gao
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Tyler S
TS
Olson
Des Moines Orthopaedic Surgeons, Des Moines, Iowa.
Christopher C
CC
Dickinson
Des Moines Orthopaedic Surgeons, Des Moines, Iowa.
Rhonda J
RJ
Chalus
Des Moines Orthopaedic Surgeons, Des Moines, Iowa.
David A
DA
Vittetoe
Des Moines Orthopaedic Surgeons, Des Moines, Iowa.
Devon D
DD
Goetz
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
John J
JJ
Callaghan
D000368:Aged; D000818:Animals; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015897:Comorbidity; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000150:complications* / Q000453:epidemiology; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000276:immunology*; D011184:Postoperative Period; D011446:Prospective Studies; D011795:Surveys and Questionnaires
Short Form-36; WOMAC; allergy; patient-reported outcomes; prospective cohort; total joint arthroplasty