Postoperative Complications in Patients with Hereditary Hemochromatosis Undergoing Total Joint Arthroplasty: A Matched Cohort Analysis

Aims:The purpose of this study is to determine differences in the rates of 90-day postoperative complications and 2-and 5-year surgical outcomes between patients with and without hereditary hemochromatosis (HH) after total joint arthroplasty (TJA).Methods:Patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) from 2010 to 2018 were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases-9/10 codes. Patients with a history of HH were identified within the THA and TKA cohorts and matched with non-HH patients based on age, sex, Charlson Comorbidity Index, smoking status, and obesity (body mass index > 30). Ninety-day medical complications assessed included renal failure, arrhythmia, bleeding complications, blood transfusion, pneumonia, stroke, deep vein thrombosis, liver failure, heart failure, pulmonary embolism, sepsis, surgical site infection, wound dehiscence, readmission rate, and death. Two-and 5-year surgical complications assessed included all-cause revision, prosthetic joint infection, implant loosening, joint stiffness, and manipulation under anesthesia. All complications were analyzed using bivariate analysis and logistic regression, with significance set at P < 0.05.Results:Compared with non-HH patients, patients with HH had higher rates of stiffness at 2 and 5 years after THA (all, P < 0.001), as well as higher rates of aseptic loosening at 5 years after TKA (P = 0.036). However, patients with HH undergoing THA and TKA had no notable difference in 90-day postoperative complications when compared with non-HH patients.Discussion:Compared with non-HH patients, patients with HH undergoing TJA were shown to have worse 2-and 5-year surgical outcomes, without any increased risk of 90-day medical complications. These findings may be useful for surgical decision making for patients with HH undergoing TJA.Clinical Relevance:This study addresses a paucity in the current literature concerning the complication profile in HH patients with destructive joint arthropathy undergoing joint arthroplasty surgery.