The Impact of Epilepsy on Complication Rates After Total Joint Arthroplasty: A Propensity Score–Matched Cohort Study

• Published in: The Journal of arthroplasty 2023-02, Vol.38 (2), p.209-214.e1
• Main Authors: Cole, Matthew W., Waters, Timothy L., Ross, Bailey J., Collins, Lacee K., Williams, Garrett H., Sherman, William F.
• Format: Article
• Language: English
• Subjects: antiepileptic; arthroplasty; Arthroplasty, Replacement, Hip - adverse effects; Cohort Studies; complications; epilepsy; Epilepsy - surgery; hip; Humans; knee; Propensity Score; Retrospective Studies; Risk Factors
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2022.08.022

It is unclear how epilepsy may affect total joint arthroplasty outcomes. The purpose of this study is to analyze the impact of epilepsy on prosthesis-related complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). A retrospective cohort study was conducted using a national database. Patients who have epilepsy underwent a primary THA (n = 6,981) and TKA (n = 4,987) and were matched 1:4 (THA, n = 27,924; TKA, n = 19,948). Rates of low-energy falls and prosthesis-related complications within 2 years postoperatively were compared for patients who did and did not have epilepsy with multivariable logistic regression. After primary TKA, patients who have epilepsy exhibited significantly higher rates of aseptic revision (4.3% versus 3.5%, odds ratio [OR] 1.21, P = .017) and revision for prosthetic joint infection (1.8% versus 1.3%, OR 1.29, P = .041). THA patients who have epilepsy exhibited significantly higher rates of prosthetic dislocation (3.2% versus 1.9%, OR 1.54, P < .001), periprosthetic fracture (2.2% versus 0.8%, OR 2.39, P < .001), and aseptic loosening (1.7% versus 1.1%, OR 1.40, P = .002). Rates of low-energy falls within 2 years after TKA (14.1% versus 6.4%, OR 2.19, P < .001) and THA (33.6% versus 7.5%, OR 5.95, P < .001) were also significantly higher for patients who have epilepsy. Epilepsy was associated with significantly higher rates of falls (P < .001) and prosthesis-related complications after primary THA (P < .05) and TKA (P < .05). Precautions should be implemented in this population during intraoperative and perioperative decision-making to reduce complication risk. Level III.