Total Hip Arthroplasty in Gout Linked to Medical, Surgical Complications

Quanjun Cui, MD

Credit: University of Virginia

Primary total hip arthroplasty (THA) in patients with gout was linked to an increased risk of multiple medical complications, including deep vein thrombosis (DVT) and acute kidney injury (AKI), as well as surgical complications, including wounds and periprosthetic joint infection (PJI), according to a recent retrospective analysis.¹

“The findings provide insights into the planning and expectation of orthopedic surgery for patients with gout,” wrote the investigative team, led by Quanjun Cui, MD, department of orthopedic surgery, University of Virginia School of Medicine.

Gout marks the most common form of inflammatory arthritis globally, with the aging population at risk, as the likelihood of gout rises with age.² It manifests as intermittent episodes of severe joint flares and its presence has been linked to various comorbidities, including cardiovascular disease and renal disease.³

Management of gout flares is comprised of early anti-inflammatory treatment, followed by urate-lowering therapy (ULT). Due to the inflammatory response of gout, Cui and colleagues indicated the critical nature of identifying the impact of gout on orthopedic surgical outcomes.

THA is a highly effective surgical procedure for advanced hip diseases, with a demand surge in the United States.⁴ However, there is little to no research on the effect of gout on primary THA outcomes in patients with a history of gouts. Citing this gap, investigators investigated post-THA complications in patients with or without gout in the national private payer PearlDiver Patient Records Database.¹

The database was searched for patients aged ≥35 years with records of any gouty arthritis before undergoing primary THA and who had 2 years of follow-up. A control cohort was matched using randomized allocation with a 1:5 ratio to the respective gout group by age, sex, and comorbidity presence.

Medical complications of interest within 90 days of THA included pneumonia, pulmonary embolism (PE), cerebrovascular accident, DVT, transfusion, AKI, urinary tract infection (UTI), sepsis, and myocardial infarction. Relevant surgical complications in the same period consisted of wound complications, PJI with or without sinus tracts, dislocation, aseptic loosening, periprosthetic fracture, and revision within 90 days, 1 year, and 2 years postoperatively.

Overall, 193,980 patients undergoing primary THA were identified, of which 32,446 had gout and 161,514 did not have gout. Multivariate regression analysis patients with gout were at a higher risk for medical complications after primary THA, including DVT, transfusion, AKI, and UTI versus non-gout patients (P <.001).

Those with gout also demonstrated increased rates of PE (P = .017). However, the likelihood of pneumonia, cerebrovascular accidents, sepsis incidence, or myocardial infarction did not differ significantly between gout and non-gout patients.

Meanwhile, the incidence of surgical complications was higher in patients with gout, including wound complications and PJIs within 90 days, with extension to 1 year and 2 years (P <.001). Those with gout also experienced an elevated risk of revision within 90 days (P = .003), 1 year (P = .027), and 2 years (P = .039).

Patients with gout showed a slightly increased dislocation risk within 90 days (P = .022) and 1 year (P = .047), but no significant difference was identified at the 2-year mark. There were no notable differences between gout and non-gout cohorts in aseptic loosening or periprosthetic fracture. Individuals with gout experienced a higher incidence of emergency department (ED) visits within 90 days and hospital readmissions (P <.001).

“In conclusion, the results demonstrate that primary THA in gout patients is associated with an elevated risk of multiple medical complications,” Cui and colleagues wrote. “In addition, gout patients exhibited higher surgical complications encompassing wound complications, PJI, dislocation, and revision.”

References

1. _{Zhang Z, Yang H, Xu Z, Chi J, Cui Q. Total Hip Arthroplasty Outcomes in Patients with Gout: A Retrospective Analysis of Matched Large Cohorts. Clin Orthop Surg. 2024;16(4):542-549. doi:10.4055/cios24039}
2. _{Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol. 2020;16(7):380-390. doi:10.1038/s41584-020-0441-1}
3. _{Dalbeth N, Gosling AL, Gaffo A, Abhishek A. Gout [published correction appears in Lancet. 2021 May 15;397(10287):1808. doi: 10.1016/S0140-6736(21)01010-2]. Lancet. 2021;397(10287):1843-1855. doi:10.1016/S0140-6736(21)00569-9}
4. _{Patel I, Nham F, Zalikha AK, El-Othmani MM. Epidemiology of total hip arthroplasty: demographics, comorbidities and outcomes. Arthroplasty. 2023;5(1):2. Published 2023 Jan 3. doi:10.1186/s42836-022-00156-1}