PMID- 37914037
OWN - NLM
STAT- MEDLINE
DCOM- 20240315
LR  - 20240315
IS  - 1532-8406 (Electronic)
IS  - 0883-5403 (Linking)
VI  - 39
IP  - 4
DP  - 2024 Apr
TI  - Osteoporosis and Total Knee Arthroplasty: Higher 5-Year Implant-Related 
      Complications.
PG  - 948-953.e1
LID - S0883-5403(23)01091-4 [pii]
LID - 10.1016/j.arth.2023.10.045 [doi]
AB  - BACKGROUND: The risk of revision surgery in patients who have osteoporosis after 
      total knee arthroplasty (TKA) is understudied. Our aim was to compare the 5-year 
      cumulative risk of revision surgery after TKA in patients who have preoperative 
      osteoporosis. METHODS: A national administrative claims database was queried for 
      patients undergoing primary TKA from 2010 to 2021. There were 418,054 patients 
      included, and 41,760 (10%) had osteoporosis. The 5-year incidence of revision 
      surgery was examined for all-causes, periprosthetic fracture (PPF), aseptic 
      loosening, and periprosthetic joint infection (PJI). A multivariable analysis was 
      conducted using Cox proportional hazards models. Hazards ratios (HRs) were 
      reported with 95% confidence intervals (CIs). RESULTS: The 5-year rate of 
      all-cause revision surgery was higher for patients who had osteoporosis (HR 1.1, 
      95% CI: 1.0 to 1.2), however, the highest risk of revision surgery was seen for 
      PPF (HR 1.8, 95% CI: 1.6 to 2.1). Patients who had osteoporosis also had elevated 
      risk of revision surgery for PJI (HR 1.2, 95% CI: 1.1 to 1.3) and aseptic 
      loosening (HR 1.2, 95% CI: 1.1 to 1.3). Osteoporosis was independently associated 
      with PJI and aseptic loosening at a higher rate in obese patients. CONCLUSIONS: 
      In unadjusted survival analysis, those who had osteoporosis have a marginally 
      lower risk of all-cause revision surgery. However, after controlling for age, sex 
      and comorbidities, patients who had osteoporosis have a nearly 2-fold increased 
      risk of 5-year revision for PPF after TKA, and mildly increased risk of revision 
      for all causes, aseptic loosening, and PJI. Obesity may also modulate this 
      association. Future studies should determine the extent to which treatment of 
      osteoporosis modifies these postoperative outcomes.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - Harris, Andrew B
AU  - Harris AB
AD  - Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, 
      Maryland.
FAU - Lantieri, Mark A
AU  - Lantieri MA
AD  - Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, 
      Maryland.
FAU - Agarwal, Amil R
AU  - Agarwal AR
AD  - Department of Orthopaedic Surgery, The George Washington University School of 
      Medicine and Health Sciences, Washington, District of Columbia; Department of 
      Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
FAU - Golladay, Gregory J
AU  - Golladay GJ
AD  - Department of Orthopaedic Surgery, Virginia Commonwealth University School of 
      Medicine, Richmond, Virginia.
FAU - Thakkar, Savyasachi C
AU  - Thakkar SC
AD  - Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, 
      Maryland.
LA  - eng
PT  - Journal Article
DEP - 20231030
PL  - United States
TA  - J Arthroplasty
JT  - The Journal of arthroplasty
JID - 8703515
SB  - IM
MH  - Humans
MH  - *Arthroplasty, Replacement, Knee/adverse effects
MH  - *Prosthesis-Related Infections/epidemiology/etiology/surgery
MH  - Prosthesis Failure
MH  - Risk Factors
MH  - *Periprosthetic Fractures/epidemiology/etiology/surgery
MH  - *Osteoporosis/complications/epidemiology
MH  - Reoperation/adverse effects
MH  - Retrospective Studies
OTO - NOTNLM
OT  - aseptic loosening
OT  - osteoporosis
OT  - periprosthetic fracture
OT  - periprosthetic joint infection
OT  - revision
OT  - total knee arthroplasty
EDAT- 2023/11/02 00:42
MHDA- 2024/03/15 06:44
CRDT- 2023/11/01 20:30
PHST- 2023/07/18 00:00 [received]
PHST- 2023/10/18 00:00 [revised]
PHST- 2023/10/20 00:00 [accepted]
PHST- 2024/03/15 06:44 [medline]
PHST- 2023/11/02 00:42 [pubmed]
PHST- 2023/11/01 20:30 [entrez]
AID - S0883-5403(23)01091-4 [pii]
AID - 10.1016/j.arth.2023.10.045 [doi]
PST - ppublish
SO  - J Arthroplasty. 2024 Apr;39(4):948-953.e1. doi: 10.1016/j.arth.2023.10.045. Epub 
      2023 Oct 30.