Chronic Oral Corticoteroid Use and 10-Year Incidence of Major Complications Following Total Knee Arthroplasty

Authors

Mark Haft, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: mhaft2@jh.edu.
Sanjay Kubsad, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Orthopaedic Surgery, University of Washington School of Medicine, Seattle, WA.
John M. Pirtle, West Virginia School of Osteopathic Medicine, Lewisburg, WV.
Amil R. Agarwal, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Rachel Ranson, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Thomas Fraychineaud, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC.
James DeBritz, 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

4-20-2024

Journal

The Journal of arthroplasty

DOI

10.1016/j.arth.2024.04.048

Keywords

Chronic Corticosteroids; Implant Survivorship; Revision; Total Knee Arthroplasty; fragility fracture; periprosthetic fracture; prosthetic joint infection

Abstract

INTRODUCTION: Oral corticosteroids are the primary treatment for several autoimmune conditions. The risk of long-term implant, bone health, and infectious-related complications in patients taking chronic oral corticosteroids before total knee arthroplasty (TKA) is unknown. We compared the 10-year cumulative incidence of revision, periprosthetic joint infection (PJI), fragility fracture (FF), and periprosthetic fracture (PPF) following TKA in patients who had and did not have preoperative chronic oral corticosteroid use. METHODS: A retrospective cohort analysis was conducted using a national database. Primary TKA patients who had chronic preoperative oral corticosteroid use were identified using Current Procedural Terminology and International Classification of Disease 9 and 10 codes. Exclusion criteria included malignancy, osteoporosis treatment, trauma, and < 2-year follow-up. Primary outcomes were 10-year cumulative incidence and hazard ratios (HR) of all-cause revision (ACR), aseptic revision, PJI, FF, and PPF. A Kaplan-Meier analysis and a multivariable Cox proportional hazards model were utilized. Overall, 611,596 patients were identified, and 5,217 (0.85%) were prescribed chronic corticosteroids. There were 10,000 control patients randomly sampled for analysis. RESULTS: Corticosteroid patients had significantly higher 10-year HR of FF [HR; 95% CI [confidence interval]; P-value (1.47; 1.34 to 1.62; P < 0.001)], ACR (1.21; 1.05 to 1.40; P = 0.009), and PJI (1.30; 1.01 to 1.69; P = 0.045) when compared to the control. DISCUSSION: Patients prescribed preoperative chronic oral corticosteroids had higher risks of ACR, PJI, and FF within 10 years following TKA compared to patients not taking corticosteroids. This information can be used by surgeons during preoperative counseling to educate this high-risk patient population about their increased risk of postoperative complications.

APA Citation

Haft, Mark; Kubsad, Sanjay; Pirtle, John M.; Agarwal, Amil R.; Ranson, Rachel; Fraychineaud, Thomas; DeBritz, James; Thakkar, Savyasachi C.; and Golladay, Gregory J., "Chronic Oral Corticoteroid Use and 10-Year Incidence of Major Complications Following Total Knee Arthroplasty" (2024). GW Authored Works. Paper 4696.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4696

Department

Orthopaedic Surgery