Previous History of Breast Cancer Increases Rates of Pulmonary Embolism and Costs after Total Knee Arthroplasty: An Evaluation of 185,114 Matched Patients

Abstract

Risk factors for adverse events after total knee arthroplasty (TKA) relating to malignancy have not been well studied. Thus, the purpose of this study was to conduct a retrospective case-control outcome and cost analysis after TKA in this population. Patients with a history of breast cancer (BrCa) were identified based on the International Classification of Disease 9th revision codes. An age- and sex-matched cohort was also identified of patients without a history of BrCa. Complications, length of stay, comorbidity burden, and reimbursements were tracked at 90 days. Each cohort comprised 92,557 patients. Length of stay was similar between cohorts ( = 0.627). Comorbidity status and incidence of pulmonary embolism (PE), lower extremity ultrasound, and chest computed tomography (CT) use were higher in patients with a history of BrCa ( < 0.05 for all). Control patients had a lower incidence of acute myocardial infarction (0.14 vs. 0.21%; < 0.001). Surgical complications were similar. The 90-day reimbursements were greater in patients with a history of BrCa (US$13,990 vs. US$13,033 for controls; = 0.021). Surgeons should be aware of the increased risk of PE after TKA in patients with a history of BrCa as well as increased 90-day costs, which warrant great attention.

A History of Past Prostate Cancer Still Carries Risk After Total Knee Arthroplasty

“…Our findings of 1.44 vs. 0.4% (PCa vs. without PCa, respectively) PE rates in these cohorts are similar to what has been reported in the literature for patients with breast cancer (0.56% without and 0.65% with a history of breast cancer). 8 Nonetheless, the difference seen here of more than 3x the incidence should be highlighted and further studied. In the initial article evaluating outcomes of TKA/total hip arthroplasty (THA) patients with a history of malignancy, Karam et al reported a comparable difference in PE rates to the one seen here, with a 1.36% incidence of those with a history of cancer versus 1.05% in those without, although their sample size was far more heterogenous (including THA/TKA, revision and bilateral procedures, history, and active malignancy and various types of malignancies among other) and smaller to ours (n ¼ 26,415).…”

“…Similar to our findings here, we have found that breast cancer in TKA also increased the 90day reimbursement rates and as such believe that accounting for this comorbidity warrants further research. [7][8][9]…”

“…The comorbidities included in the matching process were diabetes, smoker status, obesity, chronic kidney disease, alcohol consumption, and chronic liver disease as has been previously done. 8 Patients were matched to controls at a 1:1 ratio.…”

“…6 Moreover, our group previously found a correlation between increased complications and patients with a history of breast cancer receiving a total knee or hip replacement, which further highlights the need for further research in this topic to the level of disease-specific cancer evaluation. 8,9 To our knowledge, a history of prostate cancer (PCa) has not been evaluated as a specific identifiable risk factor for complications. This connection as a possible risk factor becomes significantly important due to the increasing prevalence and incidence of PCa seen worldwide and among the elderly.…”

Correlation between the Laboratory Test Results and Knee Functional Improvement of Pre- and Post-Total Knee Replacement Operation

“…In 1974, the first patellar replacement was introduced as well as joint surface replacing. After that, scientists developed the method of installing prosthesis with bone-cement and retaining anterior and posterior cruciate ligaments [8].…”