Abstract
Background
Substance abuse and dependence is thought to have a strongly negative impact on surgical outcomes. The purpose of this study was to determine the effects of drug misuse on total knee arthroplasty (TKA) revision incidence, revision causes, and time to revision by analyzing the Medicare database between 2005–2012.
Methods
A retrospective review of the Medicare database within the PearlDiver Supercomputer (Warsaw, IN) for TKA and revisions was performed utilizing Current Procedural Terminology (CPT) and International Classification of Disease (ICD) ninth revision codes. Drug misuse was subdivided into cocaine, cannabis, opioids, sedative/hypnotic/anxiolytic, amphetamines, and alcohol. Time to revision, age, and gender were also investigated.
Results
Our query returned 2159221 TKAs and 193024 (8.9%) revisions between 2005–2012. Drug misuse was prevalent in 173513 (8%). Cocaine had the highest revision incidence (13.9%). Cannabis had the fastest average (636.1 days) and median (457 days) time to revision. At 30 and 90 days, cannabis had the greatest rate of revision at 6% and 12% respectively. At 6 months and 1 year, amphetamine had the greatest revision risk at 25% and 40.5% respectively. Infection was the most common cause of revision among all substances.
Conclusion
Cocaine misuse holds the highest risk for revision. However cannabis misuse is more likely to require revision sooner, particularly at the 30 and 90 day intervals. Infection was the most common cause of revision regardless of substance misused. Thus it is important to obtain a detailed social history on drug misuse and to be vigilant for postoperative infections in these patients.
