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

  • Symposium: Papers Presented at the Annual Meetings of The Knee Society
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Clinical Orthopaedics and Related Research®



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.

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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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Corresponding author

Correspondence to Kevin J. Bozic MD, MBA.

Additional information

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This work was performed at the University of California, San Francisco and Exponent, Inc.

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Bozic, K.J., Lau, E., Kurtz, S. et al. Patient-related Risk Factors for Postoperative Mortality and Periprosthetic Joint Infection in Medicare Patients Undergoing TKA. Clin Orthop Relat Res 470, 130–137 (2012).

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