Outcomes of Total Joint Arthroplasty Subsequent to Ostomy: A Case Series.

Background: Ostomy surgery is associated with a high rate of postoperative complications and poses several theoretical concerns for subsequent total joint arthroplasty (TJA). There is concern that ostomy may negatively impact nutrition or increase risk of known gastrointestinal (GI) complications such as obstruction, constipation, or diarrhea, particularly with the use of postoperative opioids. There is also concern that the open nature of the ostomy may increase the risk of infection. This case series reports outcomes and assesses the risk associated with TJA in patients with previous surgical history of intestinal ostomy. Methods: This is an institutional review board-approved retrospective case series of patients with surgical history of ostomy who underwent total hip or total knee arthroplasty. Cohort consisted of 14 cases in 10 patients and was examined to report individual TJA and ostomy procedural details and outcomes. Results: Of the 14 cases, none required GI clearance or prophylaxis outside of standard perioperative antibiotics prior to TJA surgeries, and all TJAs resulted in good outcomes. Four cases (29%) had a complication, although only 2 of these were GI complications and none were life-threatening or required further surgery. The first of the 2 experienced increased ostomy output, and symptoms were resolved promptly with rehydration. The second experienced decreased ostomy output, and symptoms were resolved promptly with changes in prn pain medications. Other complications were postoperative urinary tract infection and syncopal episode. Conclusions: TJA can be performed safely in the setting of ostomy with major consideration being risk of diarrhea or constipation during postoperative period.