Background The impact of previous SARS-CoV-2 infection on the morbidity of elective total joint arthroplasty (TJA) is not fully understood. This study reports on the association between previous COVID-19 disease, hospital length of stay (LOS), and in-hospital complications after elective primary TJA. Methods Demographics, comorbidities, LOS, and in-hospital complications of consecutive 340 patients with history of COVID-19 were compared to 5,014 patients without history of COVID-19 undergoing TJA. History of COVID-19 was defined as a positive IgG antibody test for SARS-CoV-2 before surgery. All patients were given both antibody and PCR tests prior to surgery. Results Patients with history of COVID-19 were more likely to be obese (43.8% vs. 32.4%, p<0.001), Black (15.6% vs. 6.8%, p<0.001) or Hispanic (8.5% vs. 5.4%, p=0.028) compared to patients without history of COVID-19. COVID-19 treatment was reported by 6.8% of patients with a history of COVID-19. Patients with history of COVID-19 did not have a significantly longer median LOS after controlling for other factors (for hip replacements, median 2.9h longer, 95% CI -2.0 to 7.8, p=0.240;for knee replacements, median 4.1h longer, 95% CI -2.4 to 10.5, p=0.214) but a higher percentage were discharged to a post-acute care facility (4.7% vs. 1.9%, p=0.001). There was no significant difference in in-hospital complication rates between the two groups (0/340=0.0% versus 22/5,014=0.44%, p=0.221). Conclusion We do not find differences in LOS or in-hospital complications between the two groups. However, more work is needed to confirm these findings, particularly for patients with a history of more severe COVID-19. Level of evidence II
History of COVID-19 Was Not Associated with Length of Stay or In-Hospital Complications After Elective Lower Extremity Joint Replacement