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Increased rate of complications following total knee arthroplasty in patients with systemic sclerosis

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Abstract

Purpose

Outcomes after total knee arthroplasty (TKA) for patients with systemic sclerosis (SSc) are poorly documented in the literature. The purpose of this study was to evaluate SSc as a potential risk factor for increased rate of complications after TKA.

Methods

Using the PearlDiver Mariner database, 2,002 patients with SSc undergoing primary TKA were identified and compared to matched controls of 19,892 patients without SSc. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to two years. 90-day ED-visit and inpatient readmission were also documented.

Results

Compared to the matched controls, patients with SSc demonstrated higher rates of medical complications such as cerebrovascular accident (1.5% vs 0.6%, p < 0.001), myocardial infarction (1.3% vs 0.3%, p < 0.001), and sepsis (1.1% vs 0.4%, p < 0.001). Additionally, patients with SSc displayed elevated rates of surgical complications, including wound complications (3.9% vs 2.2%, p < 0.001) and aseptic loosening at 90 days (0.2% vs 0.1%; OR 3.53 [1.13–9.28]), one year (0.7% vs 0.4%; OR 1.78 [0.96–3.05]), and two years (1.4% vs 0.9%; OR 1.68 [1.10–2.45]). Patients with SSc also had higher rates of emergency department visits (21.2% vs 11.4%, p < 0.001).

Conclusions

Patients with SSc are at higher risks of postoperative complications, encompassing both medical and surgical complications. Specifically, patients with SSc have a significantly higher likelihood of experiencing wound complications, cerebrovascular accident, and myocardial infarction. It is crucial for orthopaedic surgeons and patients alike to consider the elevated risks when determining a course of TKA for patients with SSc.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA

    Elizabeth Driskill, Zhichang Zhang, Jialun Chi & Quanjun Cui

  2. Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, Henan, China

    Zhichang Zhang

  3. Charlottesville, USA

    Quanjun Cui

Authors
  1. Elizabeth Driskill
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  2. Zhichang Zhang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Elizabeth Driskill, Zhichang Zhang, Jialun Chi, and Quanjun Cui. The first draft of the manuscript was written by Elizabeth Driskill and Zhichang Zhang, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Quanjun Cui.

Ethics declarations

Ethics approval and content

This retrospective research study utilized the PearlDiver Patient Records Database, a national private payer insurance database that contains indexed and de-identified data. The database consists of procedural volumes and patient demographics for patients with International Classification of Diseases, 9th Revision diagnoses (ICD-9), 10th Revision diagnoses (ICD-10), and procedures or Current Procedural Terminology (CPT) codes. Our Institutional Review Board deemed this study exempt, including the need for participants' consent to participate and publish the results.

Competing interests

“Financial interests: Author Elizabeth Driskill, Zhichang Zhang, and Jialun Chi, declare they have no financial interests. Author Quanjun Cui has received research support from Depuy and Exactech, royalty from Elsevier.

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Driskill, E., Zhang, Z., Chi, J. et al. Increased rate of complications following total knee arthroplasty in patients with systemic sclerosis. International Orthopaedics (SICOT) 47, 2563–2569 (2023). https://doi.org/10.1007/s00264-023-05873-z

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