Osteoporosis and Total Knee Arthroplasty: Higher 5-Year Implant-Related Complications

Authors

Andrew B. Harris, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
Mark A. Lantieri, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
Amil R. Agarwal, 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.
Gregory J. Golladay, Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
Savyasachi C. Thakkar, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.

Document Type

Journal Article

Publication Date

10-30-2023

Journal

The Journal of arthroplasty

DOI

10.1016/j.arth.2023.10.045

Keywords

aseptic loosening; osteoporosis; periprosthetic fracture; periprosthetic joint infection; revision; total knee arthroplasty

Abstract

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.

APA Citation

Harris, Andrew B.; Lantieri, Mark A.; Agarwal, Amil R.; Golladay, Gregory J.; and Thakkar, Savyasachi C., "Osteoporosis and Total Knee Arthroplasty: Higher 5-Year Implant-Related Complications" (2023). GW Authored Works. Paper 3534.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3534

Department

School of Medicine and Health Sciences Student Works