Incarcerated Patients Are More Likely to Undergo Reoperation After Elective Total Joint Arthroplasty than Nonincarcerated Patients

Abstract

Background: Little is known regarding outcomes of incarcerated patients undergoing total joint arthroplasty. This retrospective cohort study compared complication profiles for incarcerated patients who underwent total hip or knee arthroplasty to nonincarcerated patients.

Methods: After institutional review board approval, all incarcerated patients who underwent primary total joint arthroplasty at a single academic institution from January 1, 2000, to May 9, 2024, were reviewed. The cohort of incarcerated patients was propensity score matched to nonincarcerated patients based on age, sex, body mass index, and Charlson Comorbidity Index. The primary outcome was reoperation. The secondary outcomes were intraoperative complications, wound complications, and infections. A conditional logistic regression analysis was performed to compare outcomes between cohorts and then stratified by hepatitis C status and smoking, given the high incidence in the incarcerated population.

Results: Incarcerated patients had significantly higher rates of reoperation, wound complications, infections, and deep infections (odds ratio [OR] 3.51, 2.88, 5.49, and 5.77, respectively, all P < 0.05), while no differences in intraoperative complication rates were seen (2.2 versus 1.5%, P = 1.00). Incarcerated patients had higher rates of a history of smoking (71.7 versus 40.9%, P = 0.0003) and hepatitis C (treatment status often unknown) (40.0 versus 1.5%, P < 0.0001). Incarcerated patients who had hepatitis C had a higher likelihood of wound complications and the highest likelihood of infection (OR 4.41, and 5.11, respectively; both P < 0.05). Incarcerated patients who had a history of smoking had the highest likelihood of wound complications (OR 4.67, P < 0.05).

Conclusions: Postoperative complications are more frequent in incarcerated patients, especially if they have a history of smoking or hepatitis C. Therefore, incarcerated patients should be screened preoperatively so they can undergo optimization in the form of hepatitis C treatment and smoking cessation if applicable. Surgeons treating incarcerated patients should be aware of these risk factors and complication rates.

Keywords: complications; hepatitis C; incarcerated patients; infection; total joint arthroplasty.