Incidence and Risk Factors of In‐Hospital Prosthesis‐Related Complications Following Total Knee Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

Abstract

Objective: To examine the incidence and risk factors of in-hospital prosthesis-related complications (PRCs) following total knee arthroplasty (TKA) using a large-scale national database.Methods: A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005-2014. Patients who underwent TKA were included. The recruited cases were divided into two groups according to the occurrence of PRCs. Patient demographics (age, sex, and race), hospital characteristics (type of admission and payer, and bedsize, teaching status, location, and region of hospital), length of stay (LOS), total charges during hospitalization, in-hospital mortality, comorbidities, and perioperative complications were analyzed.Results: A total of 1,227,244 TKAs were captured from the NIS database. There were 8484 cases of in-hospital PRCs after TKA and the overall incidence was 0.69%, with a slight downward trend annually. Periprosthetic joint infection (PJI) was the main category among PRCs (0.20%), followed by mechanical loosening (0.04%), dislocation (0.02%), and periprosthetic fracture (PPF) (0.01%). Patients suffered from in-hospital PRCs were 3 years younger (64 years vs 67 years) and 6.51% more likely to be male (43.60% vs 37.09%) compared to the nonaffected population (P < 0.0001). Additionally, patients experiencing in-hospital PRCs after TKA were 2.11% less likely through elective admission (92.07% vs 94.18%) while 2.34% more likely in teaching hospital (45.53% vs 43.19%) than those without these complications (P < 0.0001). Furthermore, the occurrence of in-hospital PRCs was associated with longer LOS (4 days vs 3 days; P < 0.0001), more total charges ($53,418 vs $41,204, P < 0.0001), and higher in-hospital mortality (0.30% vs 0.07%; P < 0.0001). Multivariate logistic regression was performed to identify independent risk factors of in-hospital PRCs after TKA which included younger age, male, non-elective admission, teaching hospital, deficiency and chronic blood loss anemia, coagulopathy, congestive heart failure, depression, diabetes with chronic complications, fluid and electrolyte disorders, pulmonary circulation disorders, metastatic cancer, and weight loss. Besides, inhospital PRCs after TKA were associated with secondary osteoarthritis, inflammatory arthritis, prior knee arthroscopy, acute renal failure, acute myocardial infarction, deep vein thrombosis, sepsis, transfusion, and wound dehiscence. Conclusion:It is beneficial to study the risk factors of in-hospital PRCs after TKA to ensure the appropriate management and optimize consequences although a relatively low incidence was identified.

Is thyroid disease associated with post-operative complications after total joint arthroplasty? A systematic review of the literature

“…The included studies reported no significantly different rates of aseptic loosening between groups ( 7 , 16 , 17 ) except for the study of Yang et al ( 15 ). The periprosthetic fracture rate did not differ significantly among groups in the two studies ( 7 , 14 ).…”

“…They mainly were retrospective and prospective observational and cohort studies. One study presented data on total ankle arthroplasty ( 13 ); four studies presented data on TKA ( 7 , 14 , 15 , 16 ); one study included data on THA ( 17 ); and one for total elbow arthroplasty ( 18 ). Two studies demonstrated data on both TKA and THA operations ( 19 , 20 ).…”

“…( 17 ) 2020 RC Hip 63 63 68 58 TD 53.4 56.1 78 Jing et al ( 14 ) 2021 CS Knee 398 398 700 96 TD: 64.8 65.1 25.4 Yang. et al ( 15 ) 2021 RO Knee PCR: 8484 1,218,760* 771,385 455,859 PCR: 64 67 N/A *No PCRs; † includes non-thyroid disease. CS, cohort study; PCR, prosthesis-related complications; PJI, periprosthetic joint infection; RC, retrospective cohort; RO, retrospective observational; TD, thyroid disease; TAA, total ankle arthroplasty; TJA, total joint arthroplasty.…”

“…Three cohort studies ( 7 , 14 , 16 ) were measured to be of high methodological quality and one ( 17 ) of moderate quality. A cross-sectional study was of high ( 20 ), three of moderate ( 15 , 19 , 21 ), and one of low methodological quality ( 18 ). The quality assessment outcomes are summarized in Supplementary Appendix 1 and 2 (see section on supplementary materials given at the end of this article).…”

Effect of Diabetes Mellitus on Implant Osseointegration of Titanium Screws: An Animal Experimental Study

“…4 With an aging and rapidly growing population with DM, a large number of patients with DM are likely to undergo orthopedic surgery. [5][6][7][8][9][10][11] Observational studies have shown that DM is associated with a higher rate of perioperative complications, [12][13][14] such as surgical site infection, implant loosening, and fracture non-union. Among the reported complications, implant loosening commonly leads to orthopedic surgical revision and remains the major factor limiting the survival of orthopedic implants.…”