Primary immunodeficiency disorders increase the risk of postoperative complications following total hip and knee arthroplasty: A national matched cohort study.

Abstract

Total hip (THA) and knee arthroplasty (TKA) are widely successful procedures but remain susceptible to complications. Patients with primary immunodeficiency (PI) conditions may face increased postoperative risks, though data is limited. This study evaluated postoperative outcomes after THA and TKA in PI patients, hypothesizing higher complication rates compared with matched controls. A retrospective cohort study was conducted using the PearlDiver Mariner database (2010-2020). Patients undergoing primary THA or TKA were identified by CPT codes and matched 1:1 by age, sex, and Charlson Comorbidity Index, obesity, tobacco use, alcohol abuse, and osteoarthritis. Patients with PI conditions were identified with a comprehensive list of International Classification of Diseases (ICD) 9/10 codes. Postoperative complications were assessed at 90 days, 1 year, and 2 years. Multivariable logistic regression was used to identify independent associations with PI status. After 1:1 matching, PI patients had significantly higher 90-day postoperative incidence of deep vein thrombosis (DVT), pneumonia, urinary tract infection (UTI), and any complication following THA. At 1 year, PI patients were found to have increased odds of periprosthetic joint infection (PJI), DVT, acute kidney injury (AKI), pneumonia, UTI, and any complication. 2 years postoperatively, PI was associated with increased odds of PJI revision. Within 90 days of TKA, PI patients displayed a higher incidence of surgical site infection (SSI), AKI, wound disruption, pneumonia, UTI, readmission, and any complication. After one year, PI patients had higher rates of PJI, SSI, DVT, AKI, wound disruption, pneumonia, UTI, readmission, and any complication. At 2 years follow up, there were no significant differences between groups. In patients undergoing THA and TKA, PI was associated with significantly higher odds of infectious and medical complications, despite lower overall rates of metabolic comorbidities. These findings highlight the need for PI-specific perioperative protocols to improve both clinical outcomes and economic benefits.