30-Days to 10-Years Mortality Rates following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of the Last Decade (2011–2021)

Abstract

Background Mortality data following primary total knee arthroplasty (TKA) beyond the 1-year postoperative time period is sparse. This systematic review and meta-analysis aimed to: 1) estimate contemporary mortality rates at 30-days, 90-days, 1-year, 5-years, and 10-years following primary TKA; and 2) identify risk factors and causes of mortality following TKA. Methods PubMed, MEDLINE, Cochrane, EBSCO host, and Google Scholar databases were queried from January 1, 2011 to October 30, 2021 for all studies reporting mortality rates following primary TKA. A meta-analysis of proportions was conducted using a random-effects model to ascertain pooled mortality rates (95% confidence interval [CI]). Meta-regression was utilized to account for confounding effects on mortality rates due to the study’s country of origin, median date of study data, average patient age, and patient gender ratios, with a level of significance maintained at P-value <0.05. Results A total of 44 articles were included in quantitative synthesis. The pooled 30-day mortality rate was 0.14%(95% CI:0.05%-0.22%; n=1,817,647). The pooled 90-day mortality rate was 0.35%(95% CI:0.0.28%-0.43%; n=1,641,974). The pooled 1-year mortality was 1.1%(95% CI:0.71%-1.49%; n=1,178,698). The pooled 5-year mortality rate was 5.38%(95% CI:4.35%-6.42%; n=597,041). The pooled 10-year mortality rate was 10.18%(95% CI:7.78 %-12.64 %; n=815,901). Our 30-day mortality rate was lower than previously reported. The most common causes of death at all time points were due to cardiac disease, cerebrovascular disease, and malignancy. Obesity demonstrated mixed effects on long term mortality rates. Conclusion Overall mortality rates of TKA remain low worldwide at all time points and immediate postoperative mortality rates continue to fall. Compared to symptomatic knee osteoarthritic patients reported in the literature, TKA patients qualitatively exhibited lower mortality rates, which may support the value of TKA in improving quality of life without associated excess mortality. Future long-term mortality studies should be conducted to account for geographical variability in mortality rates and further elucidate modifiable risk factors associated with mortality among TKA patients.

5-Factor Modified Frailty Index as a Predictor of Outcomes After Hemiarthroplasty or Total Hip Arthroplasty for Femoral Neck Fracture

“…It has been well-established that patients with preexisting comorbidities demonstrate poorer outcomes after major joint arthroplasties. 16,19-24 In a NSQIP analysis conducted by Pan et al, 19 an ASA Classification score >2, a CCI >0, and dependent functional status were associated with greater odds of nonhome discharge after total knee arthroplasty (TKA). Similarly, an analysis by Turan et al 20 showed that increasing comorbidity indices were notable risk factors for mortality after THA.…”

“…Other proven risk factors for adverse outcomes include age, obesity, smoking history, and increased Elixhauser Comorbidity Measure (ECM). 16,19,22…”