Abstract
Background
With the increasing utilization of total knee arthroplasty (TKA) in a continually
aging US population, the number of patients who have low bone mineral density who
undergo TKA may concomitantly increase. This study aimed to assess the rates of short-term
complications following TKA in patients who did and did not have a recent history
of a prior fragility fracture.
Methods
A matched retrospective cohort study analyzing 48,796 patients was performed using
a national database to determine the impact of a preceding fragility fracture on rates
of short-term complications following TKA. The rates of complications at 1 and 2 years
post-TKA were analyzed using multivariate logistic regressions.
Results
Prior fragility fracture was associated with increased rates of 1-year hospital readmissions
(hazard ratio = 1.30, 95% CI, 1.22-1.38), periprosthetic fractures (odds ratio [OR] =
2.72, 95% CI, 1.89-3.99), non–infection-related revisions (OR = 1.32, 95% CI, 1.09-1.60),
secondary fragility fractures (OR = 4.62, 95% CI, 4.19-5.12), prosthesis dislocations
(OR = 1.76, 95% CI, 1.22-2.56), prosthesis instabilities (OR = 1.64, 95% CI, 1.25-2.15),
and periprosthetic infections (OR = 1.49, 95% CI, 1.29-1.71), with similar trends
in implant-related complications also seen at the 2-year mark. Patients who filled
a prescription for osteoporosis pharmacotherapy had clinically similar rates of these
complications compared to those who did not.
Conclusion
Sustaining a fragility fracture prior to TKA is associated with an increased risk
of hospital readmission and significant implant-related postoperative complications,
potentially increasing the morbidity and mortality of TKA in these patients.
Keywords
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Article info
Publication history
Published online: August 30, 2022
Accepted:
August 24,
2022
Received in revised form:
August 22,
2022
Received:
June 24,
2022
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2022.08.036.
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