Orthostatic intolerance-type events following hip and knee arthroplasty: a systematic review and meta-analysis

Tarcisio F. de Campos; Nick Vertzyas; Mitch Wolden; Deshitha Hewawasam; Ben Douglas; Christopher McIllhatton; Jessica Hili; Chloe Molnar; Michael I. Solomon; Gregory C. Gass; Sean F. Mungovan

doi:10.2106/JBJS.22.00600

Orthostatic intolerance-type events following hip and knee arthroplasty: a systematic review and meta-analysis

Tarcisio F. de Campos, Nick Vertzyas, Mitch Wolden, Deshitha Hewawasam, Ben Douglas, Christopher McIllhatton, Jessica Hili, Chloe Molnar, Michael I. Solomon, Gregory C. Gass, Sean F. Mungovan

Department of Health Sciences

Research output: Contribution to journal › Review article › peer-review

5 Citations (Scopus)

Abstract

Background: Orthostatic intolerance (OI)-type events following hip and knee arthroplasty increase the risk of falls, hospital length of stay, and health-care costs. There is a limited understanding of the incidence of and risk factors for OI-type events in patients during the acute hospital stay. Our aim was to systematically review the incidence of and risk factors for OI-type events during the acute hospital stay following hip and knee arthroplasty.

Methods: A systematic review and meta-analysis of studies that investigated the incidence of and risk factors for OI-type events was undertaken. A comprehensive search was performed in MEDLINE, Embase, and CINAHL from their inception to October 2021. The methodological quality of identified studies was assessed using the modified version of the Quality in Prognosis Studies (QUIPS) tool.

Results: Twenty-one studies (14,055 patients) were included. The incidence was 2% to 52% for an OI event, 1% to 46% for orthostatic hypotension, and 0% to 18% for syncope/vasovagal events. Two studies reported female sex, high peak pain levels (>5 out of 10) during mobilization, postoperative use of gabapentin, and the absence of postoperative intravenous dexamethasone as risk factors. There was no consensus on the definition and assessment of an OI-type event.

Conclusions: OI-type events are common during the acute hospital stay following hip and knee arthroplasty, and 4 risk factors have been reported for OI-type events. High-quality prospective cohort studies are required to systematically and reliably determine the incidence of and risk factors for OI-type events.

Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original language	English
Pages (from-to)	239-249
Number of pages	11
Journal	Journal of Bone and Joint Surgery - Series A
Volume	105
Issue number	3
DOIs	https://doi.org/10.2106/JBJS.22.00600
Publication status	Published - 1 Feb 2023

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10.2106/JBJS.22.00600

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de Campos, T. F., Vertzyas, N., Wolden, M., Hewawasam, D., Douglas, B., McIllhatton, C., Hili, J., Molnar, C., Solomon, M. I., Gass, G. C., & Mungovan, S. F. (2023). Orthostatic intolerance-type events following hip and knee arthroplasty: a systematic review and meta-analysis. Journal of Bone and Joint Surgery - Series A, 105(3), 239-249. https://doi.org/10.2106/JBJS.22.00600

@article{5e3ee04651b948f1b7b92af6258d2338,

title = "Orthostatic intolerance-type events following hip and knee arthroplasty: a systematic review and meta-analysis",

abstract = "Background: Orthostatic intolerance (OI)-type events following hip and knee arthroplasty increase the risk of falls, hospital length of stay, and health-care costs. There is a limited understanding of the incidence of and risk factors for OI-type events in patients during the acute hospital stay. Our aim was to systematically review the incidence of and risk factors for OI-type events during the acute hospital stay following hip and knee arthroplasty.Methods: A systematic review and meta-analysis of studies that investigated the incidence of and risk factors for OI-type events was undertaken. A comprehensive search was performed in MEDLINE, Embase, and CINAHL from their inception to October 2021. The methodological quality of identified studies was assessed using the modified version of the Quality in Prognosis Studies (QUIPS) tool.Results: Twenty-one studies (14,055 patients) were included. The incidence was 2% to 52% for an OI event, 1% to 46% for orthostatic hypotension, and 0% to 18% for syncope/vasovagal events. Two studies reported female sex, high peak pain levels (>5 out of 10) during mobilization, postoperative use of gabapentin, and the absence of postoperative intravenous dexamethasone as risk factors. There was no consensus on the definition and assessment of an OI-type event.Conclusions: OI-type events are common during the acute hospital stay following hip and knee arthroplasty, and 4 risk factors have been reported for OI-type events. High-quality prospective cohort studies are required to systematically and reliably determine the incidence of and risk factors for OI-type events.Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.",

author = "{de Campos}, {Tarcisio F.} and Nick Vertzyas and Mitch Wolden and Deshitha Hewawasam and Ben Douglas and Christopher McIllhatton and Jessica Hili and Chloe Molnar and Solomon, {Michael I.} and Gass, {Gregory C.} and Mungovan, {Sean F.}",

year = "2023",

month = feb,

day = "1",

doi = "10.2106/JBJS.22.00600",

language = "English",

volume = "105",

pages = "239--249",

journal = "Journal of Bone and Joint Surgery - Series A",

issn = "0021-9355",

publisher = "Journal of Bone and Joint Surgery Inc.",

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de Campos, TF, Vertzyas, N, Wolden, M, Hewawasam, D, Douglas, B, McIllhatton, C, Hili, J, Molnar, C, Solomon, MI, Gass, GC & Mungovan, SF 2023, 'Orthostatic intolerance-type events following hip and knee arthroplasty: a systematic review and meta-analysis', Journal of Bone and Joint Surgery - Series A, vol. 105, no. 3, pp. 239-249. https://doi.org/10.2106/JBJS.22.00600

TY - JOUR

T1 - Orthostatic intolerance-type events following hip and knee arthroplasty

T2 - a systematic review and meta-analysis

AU - de Campos, Tarcisio F.

AU - Vertzyas, Nick

AU - Wolden, Mitch

AU - Hewawasam, Deshitha

AU - Douglas, Ben

AU - McIllhatton, Christopher

AU - Hili, Jessica

AU - Molnar, Chloe

AU - Solomon, Michael I.

AU - Gass, Gregory C.

AU - Mungovan, Sean F.

PY - 2023/2/1

Y1 - 2023/2/1

N2 - Background: Orthostatic intolerance (OI)-type events following hip and knee arthroplasty increase the risk of falls, hospital length of stay, and health-care costs. There is a limited understanding of the incidence of and risk factors for OI-type events in patients during the acute hospital stay. Our aim was to systematically review the incidence of and risk factors for OI-type events during the acute hospital stay following hip and knee arthroplasty.Methods: A systematic review and meta-analysis of studies that investigated the incidence of and risk factors for OI-type events was undertaken. A comprehensive search was performed in MEDLINE, Embase, and CINAHL from their inception to October 2021. The methodological quality of identified studies was assessed using the modified version of the Quality in Prognosis Studies (QUIPS) tool.Results: Twenty-one studies (14,055 patients) were included. The incidence was 2% to 52% for an OI event, 1% to 46% for orthostatic hypotension, and 0% to 18% for syncope/vasovagal events. Two studies reported female sex, high peak pain levels (>5 out of 10) during mobilization, postoperative use of gabapentin, and the absence of postoperative intravenous dexamethasone as risk factors. There was no consensus on the definition and assessment of an OI-type event.Conclusions: OI-type events are common during the acute hospital stay following hip and knee arthroplasty, and 4 risk factors have been reported for OI-type events. High-quality prospective cohort studies are required to systematically and reliably determine the incidence of and risk factors for OI-type events.Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

AB - Background: Orthostatic intolerance (OI)-type events following hip and knee arthroplasty increase the risk of falls, hospital length of stay, and health-care costs. There is a limited understanding of the incidence of and risk factors for OI-type events in patients during the acute hospital stay. Our aim was to systematically review the incidence of and risk factors for OI-type events during the acute hospital stay following hip and knee arthroplasty.Methods: A systematic review and meta-analysis of studies that investigated the incidence of and risk factors for OI-type events was undertaken. A comprehensive search was performed in MEDLINE, Embase, and CINAHL from their inception to October 2021. The methodological quality of identified studies was assessed using the modified version of the Quality in Prognosis Studies (QUIPS) tool.Results: Twenty-one studies (14,055 patients) were included. The incidence was 2% to 52% for an OI event, 1% to 46% for orthostatic hypotension, and 0% to 18% for syncope/vasovagal events. Two studies reported female sex, high peak pain levels (>5 out of 10) during mobilization, postoperative use of gabapentin, and the absence of postoperative intravenous dexamethasone as risk factors. There was no consensus on the definition and assessment of an OI-type event.Conclusions: OI-type events are common during the acute hospital stay following hip and knee arthroplasty, and 4 risk factors have been reported for OI-type events. High-quality prospective cohort studies are required to systematically and reliably determine the incidence of and risk factors for OI-type events.Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

UR - http://www.scopus.com/inward/record.url?scp=85147318148&partnerID=8YFLogxK

U2 - 10.2106/JBJS.22.00600

DO - 10.2106/JBJS.22.00600

M3 - Review article

C2 - 36723468

SN - 0021-9355

VL - 105

SP - 239

EP - 249

JO - Journal of Bone and Joint Surgery - Series A

JF - Journal of Bone and Joint Surgery - Series A

IS - 3

ER -

Orthostatic intolerance-type events following hip and knee arthroplasty: a systematic review and meta-analysis

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