Clinical Orthopaedics and Related Research®

, Volume 470, Issue 1, pp 130–137 | Cite as

Patient-related Risk Factors for Postoperative Mortality and Periprosthetic Joint Infection in Medicare Patients Undergoing TKA

  • Kevin J. Bozic
  • Edmund Lau
  • Steven Kurtz
  • Kevin Ong
  • Daniel J. Berry
Symposium: Papers Presented at the Annual Meetings of The Knee Society



The impact of specific baseline comorbid conditions on the relative risk of postoperative mortality and periprosthetic joint infection (PJI) in elderly patients undergoing TKA has not been well defined.


We calculated the relative risk of postoperative mortality and PJI associated with 29 comorbid conditions in Medicare patients undergoing TKA.

Patients and Methods

The Medicare 5% sample was used to calculate the relative risk of 90-day postoperative mortality and PJI as a function of 29 preexisting comorbid conditions in 83,011 patients who underwent primary TKA between 1998 and 2007.


The independent risk factors for 90-day postoperative mortality (in decreasing order of significance) were congestive heart failure, metastatic cancer, renal disease, peripheral vascular disease, cerebrovascular disease, lymphoma, cardiac arrhythmia, dementia, pulmonary circulation disorders, and chronic liver disease. The independent risk factors for PJI (in decreasing order of significance) were congestive heart failure, chronic pulmonary disease, preoperative anemia, diabetes, depression, renal disease, pulmonary circulation disorders, obesity, rheumatologic disease, psychoses, metastatic tumor, peripheral vascular disease, and valvular disease.


We believe this information important when counseling elderly patients regarding the risks of mortality and PJI after TKA and risk-adjusting publicly reported TKA patient outcomes.

Level of Evidence

Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.



We thank Vanessa Chiu, MPH, Harry E. Rubash, MD, and Thomas P. Vail, MD, for their assistance.

Financial support

Financial support was received from the Orthopaedic Research and Education Foundation. One or more of the authors (SK, KO, EL) are employees of Exponent, Inc. One or more of the authors (DJB) receives consulting income and royalties from DePuy, Inc.


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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Kevin J. Bozic
    • 1
  • Edmund Lau
    • 2
  • Steven Kurtz
    • 3
  • Kevin Ong
    • 3
  • Daniel J. Berry
    • 4
  1. 1.UCSF Department of Orthopaedic Surgery and Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoUSA
  2. 2.Exponent, IncMenlo ParkUSA
  3. 3.Exponent, IncPhiladelphiaUSA
  4. 4.Department of Orthopaedic SurgeryMayo ClinicRochesterUSA

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