Association of Regular Preoperative Antiplatelet and Anticoagulant Medication With Surgical Site Infection Following Total Knee Arthroplasty: A Retrospective Case Control Study

Background

Periprosthetic joint infection (PJI) is a disastrous complication following total knee arthroplasty (TKA), which can develop from a surgical site infection (SSI). The use of antiplatelet and anticoagulant medication are becoming ever more prevalent in todays ageing population and such agents but have been linked to an increased incidence of SSI during following surgical procedures. In this paper, we seek to compare the rates of SSI in those patients undergoing TKA taking preoperative anti platelet or anticoagulant

medication compared with those who were not on such medication.

Study Design & Methods

A retrospective case-control study was undertaken looking at patients who had undergone a primary TKA between July 2013 and March 2018. We then identified those who developed an SSI, and matched them to a group who did not develop a SSI by age, gender and year of operation. The rates of those on antiplatelet/antocoagulant

medication was then compared between the two.

Results

A total of 1516 TKA procedures were undertaken with 20 SSIs recorded (1.3%). Incidence of SSI was significantly higher in males (OR = 2.6; 95% CI: 1.0 to 6.5; P = 0.045). The rate of preoperative antiplatelet or anticoagulant medication use was higher in the SSI group (40.0%) than non-SSI group (30.0%), but failed to show significance (OR = 1.6; 95% CI: 0.4 to 5.8; P = 0.508). Within the SSI group, the relative risk of patients requiring a one-or-two-stage replacement, who took regular preoperative antiplatelet or anticoagulant medication, was 1.9 (95% CI: 0.7-4.9; P = 0.201).

Conclusions

The study failed to identify a significant association between the regular use of preoperative antiplatelet or anticoagulant medication with SSI following primary TKA.

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