10-Year Cumulative Incidence and Indications for Revision Total Knee Arthroplasty Among Patients who have Sickle Cell Disease

Authors

Philip M. Parel, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: pmparel2018@gwmail.gwu.edu.
Emile-Victor Kuyl, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Amil R. Agarwal, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Jordan Cohen, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
Alex Gu, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Andrew B. Harris, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Rachel A. Ranson, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Savyasachi C. Thakkar, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Gregory J. Golladay, Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA.

Document Type

Journal Article

Publication Date

3-30-2023

Journal

The Journal of arthroplasty

DOI

10.1016/j.arth.2023.03.070

Keywords

Etiology; Revision; Sickle Cell Disease; Survivorship; Total Knee Arthroplasty

Abstract

INTRODUCTION: Literature regarding total knee arthroplasty (TKA) outcomes in sickle cell disease (SCD) is limited. Moreover, 10-year survivorship of SCD implants is unknown. This study aimed to observe 10-year cumulative incidence and indications for revision TKA in patients who did and did not have SCD. METHODS: Patients who underwent primary TKA were identified using a large national database. The SCD patients were matched by age, sex, and a comorbidity index to a control cohort in a 1:4 ratio. The 10-year cumulative incidence rates were determined using Kaplan-Meier survival analyses. Multivariable analyses were conducted using Cox proportional hazard modeling. Chi-squared analyses were conducted to compare indications for revision between cohorts. In total, 1,010 SCD patients were identified, 100,000 patients included in the unmatched control, and 4,020 patients included in the matched control. RESULTS: Compared to the unmatched control cohort, SCD patients exhibited higher 10-year all-cause revision (HR: 1.86; P < 0.001) with higher proportions of revisions for periprosthetic joint infection (PJI) (P < 0.001), aseptic loosening (P < 0.001), and hematoma (P<0.001). Compared to the matched control, SCD patients had higher 10-year all-cause revision (Hazard Ratio (HR): 1.39; P = 0.034) with a higher proportion of revisions for PJI (P = 0.044), aseptic loosening (P = 0.003), and hematoma (P = 0.019). DISCUSSION: Independent of other comorbidities, SCD patients are more likely to undergo revisions for PJI, aseptic loosening, and hematoma compared to patients who do not have SCD. Due to the high-risk of these complications, peri- and postoperative surgical optimization should be enforced in SCD patients.

APA Citation

Parel, Philip M.; Kuyl, Emile-Victor; Agarwal, Amil R.; Cohen, Jordan; Gu, Alex; Harris, Andrew B.; Ranson, Rachel A.; Thakkar, Savyasachi C.; and Golladay, Gregory J., "10-Year Cumulative Incidence and Indications for Revision Total Knee Arthroplasty Among Patients who have Sickle Cell Disease" (2023). GW Authored Works. Paper 2521.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2521

Department

School of Medicine and Health Sciences Resident Works