Impact of Atopic Dermatitis (Eczema) and Its Treatment on the Risk of Adverse Events Following Total Knee Arthroplasty.

Abstract

Background: Atopic dermatitis (AD), also known as eczema, is a highly prevalent, chronic inflammatory skin condition. The perioperative outcomes of patients with AD after total knee arthroplasty (TKA) have not been characterized.

Methods: Adult patients who underwent TKA were identified in the PearlDiver administrative database. After matching based on patient characteristics, 90-day adverse events and 5-year revisions were compared by multivariable analyses and log-rank tests, respectively. Patients with atopic dermatitis were then stratified by medication status for repeated analysis between resultant subcohorts.

Results: Relative to age, sex, and comorbidity matched patients without AD, those with AD had increased odds of aggregated adverse events (OR = 1.36), pneumonia (OR = 2.07), urinary tract infection (UTI, OR = 1.77), and emergency department (ED) visits (OR = 1.70) (P < 0.0001 for each). Those on medication for moderate-to-severe disease had similar associations as the primary analysis. Those not on medications were similar, but not found to have elevated odds of pneumonia. 5-year revisions were not markedly different.

Conclusion: TKA patients with AD were at increased odds of pneumonia, UTI, and ED visits, but these risks were not exacerbated by immunosuppressive medications. Surgeons who are managing patients with AD for TKA should be vigilant but reassured by overall similar 5-year survival to revision.