Medical- and Implant-Related Complications Following Total Joint Arthroplasty in Patients Who Have Chronic Lymphocytic Leukemia

Background: Chronic lymphocytic leukemia (CLL) is highly prevalent in the total joint arthroplasty age group but has not been properly evaluated. This study aimed to assess the following: 1) 90-day medical complications, 2) implant-related complications, 3) healthcare utilization, and 4) time to revision in CLL and non-CLL total joint arthroplasty.

Methods: The CLL cases undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) were identified using diagnostic and procedural codes. The CLL TKA and THA patients were matched in a 1:5 ratio, with controls based on demographics and comorbidities. The outcomes included 90-day medical complications, 2-year implant complications, length of stay, 90-day readmission, and time to revision.

Results: The CLL TKA patients had significantly higher odds of 90-day medical complications compared to controls, notably pneumonia (OR [odds ratio], 9.2; CI [confidence interval], 7.1 to 12.0; P < 0.001) and myocardial infarction (OR, 5.5; CI, 3.9 to 7.9; P < 0.001). Similarly, CLL THA patients had greater odds of 90-day medical complications, especially pneumonia (OR 10.0; CI 8.2 to 12.2; P < 0.001) and acute kidney injury (OR 6.3; CI 5.1 to 7.8; P < 0.001). The CLL TKA patients faced higher odds of periprosthetic fracture, mechanical loosening, and prosthetic joint infection, while THA patients had increased periprosthetic fractures. Revisions occurred earlier for THA than TKA (337 ± 547 versus 643 ± 774 days). The CLL patients had longer length of stay(TKA: 5.9 ± 6.5 versus 3.1 ± 1.6 days; P < 0.001) (THA: 6.3 ± 12.9 versus 3.0 ± 2.4; P < 0.001) and higher 90-day readmission rates (OR, 1.3; CI, 1.1 to 1.5, P < 0.001).

Conclusions: Orthopaedic surgeons should consider CLL status for informed patient counseling and complications mitigation.