Higher risk of complications evident after joint replacement surgery

Infections notable in Cushing's patients following hip or knee replacement

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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People with Cushing’s syndrome are at a greater risk of developing complications, particularly infections, after undergoing hip or knee replacement surgery, a recent study reported.

“This study revealed that patients who have [Cushing’s syndrome] are at increased risk of developing early postoperative complications following [total joint replacement],” the researchers wrote. “Understanding this risk profile is important for accurate shared decision making between [Cushing’s] patients and their clinicians.”

The study, “Cushing’s Syndrome is Associated with Early Medical- and Surgical-related Complications Following Total Joint Arthroplasty: A National Database Study,” was published in The Journal of Arthroplasty.

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Cushing’s syndrome is characterized by elevated levels of the stress hormone cortisol. Cushing’s disease is a form of the syndrome, with the disease caused by a tumor in the brain’s pituitary gland.

Joint replacement, also called arthroplasty, is a surgical procedure done to replace a damaged joint with an artificial one, with the aim of easing pain and improving mobility.

Several common symptoms of Cushing’s, such as high blood pressure and elevated levels of fatty molecules in the bloodstream, are known to be risk factors for complications after joint replacement surgery. However, there hasn’t been much investigation into whether Cushing’s itself increases the risk of complications with such surgery.

This study aimed “to evaluate the association between [Cushing’s syndrome] and postoperative complication rates following TJA [total joint arthroplasty]. We hypothesized that patients … would have increased incidences of early medical- and surgical-related complications,” the researchers wrote.

Using a large U.S. healthcare record database, the team collected and analyzed data on 1,059 people with Cushing’s who underwent hip replacement and 1,561 who underwent knee replacement surgery. The team also analyzed data on thousands of people without Cushing’s who underwent these procedures, serving as a control group.

Statistical analyses showed the risk of pulmonary embolism — blockage in the vessels that carry blood to the lungs — was more than double in Cushing’s patients who underwent hip replacement surgery.

A risk of infectious complications, such as urinary tract infection (UTI), pneumonia, sepsis, and infections in the prosthetic joint, also was significantly elevated in Cushing’s patients who underwent hip replacement. The risk of UTI and pneumonia was higher among Cushing’s patients who had knee replacement surgery.

“Patients who have [Cushing’s syndrome] have an increased risk of infectious postoperative complications,” the researchers wrote, adding that “further research is warranted to identify interventions that may ameliorate this risk.”

The incidence of revision surgeries also was higher among Cushing’s patients who underwent hip replacement surgery, as were hospital readmission rates.

More postoperative emergency room visits, greater reliance on opioids

Patients also had higher rates of joint dislocations following knee replacement, and lower rates of manipulation under anesthesia (MUA). MUA involves a clinician stretching a patient’s joint while the patient is under anesthesia; it is sometimes used to help ease pain and improve mobility.

“[Cushing’s syndrome] seems to influence rates of instability and stiffness following [knee replacement] as patients in the test cohort were more likely to sustain a dislocation and less likely to undergo MUA,” the researchers wrote, adding that “further research is warranted to better understand knee stability and stiffness following [total knee replacement] among [these] patients.”

Following either type of joint replacement, people with Cushing’s had higher risks of emergency room visits. They also tended to be prescribed more opioids following surgery compared with controls.

These associations “can most likely be attributed to the increased rates of early postoperative complications within this cohort of patients,” the researchers wrote.

They noted that this analysis was limited by a lack of data on Cushing’s severity or treatments used among the studied patient group, which might have affected the outcomes.