Risk factors and postoperative complications following revision total knee arthroplasty in patients with metabolic syndrome–associated osteoarthritis: a 10-year retrospective analysis using a national inpatient database
The prevalence of MetS-OA among patients undergoing RTKA has increased over time and is associated with a higher burden of postoperative complications and healthcare utilization, and targeted preoperative optimization and standardized perioperative management strategies for patients with MetS-OA may mitigate adverse events, enhance postoperative recovery, and reduce overall hospitalization charges.
Abstract
Objective The aim of this study was to examine temporal trends in metabolic syndrome–associated osteoarthritis (MetS-OA) among patients undergoing revision total knee arthroplasty (RTKA) and to identify patient- and clinical-level factors associated with this condition and related outcomes. Methods A retrospective cohort analysis was conducted using data from the Nationwide Inpatient Sample from 2010 through 2019. Patient demographics, hospital characteristics, length of stay, total hospitalization charges, in-hospital mortality, comorbid conditions, and perioperative complications were assessed. All analyses incorporated NIS discharge weights, and multivariable logistic regression models were used to assess associations between MetS-OA and clinical outcomes among patients undergoing RTKA. Results Among 1,361,454 RTKA hospitalizations identified, 1,330,099 RTKA hospitalizations were included in the analysis. The overall prevalence of MetS-OA was 16.1%, demonstrating a progressive increase from 2011 through 2019. Factors independently associated with MetS-OA included advanced age, male sex, non-White racial background, and the presence of comorbid conditions such as chronic pulmonary disease, depression, and hypothyroidism. Patients with MetS-OA experienced slightly longer hospital stays and incurred higher median total hospitalization charges, exceeding those without MetS-OA by $1,445.50. In-hospital mortality did not differ significantly between groups. MetS-OA was also associated with a higher likelihood of postoperative complications, including acute myocardial infarction, severe malnutrition, acute cerebrovascular disease, postoperative delirium, acute respiratory distress syndrome, prolonged mechanical ventilation, urinary tract infections, acute renal failure, and lower limb nerve injury. Conclusion The prevalence of MetS-OA among patients undergoing RTKA has increased over time and is associated with a higher burden of postoperative complications and healthcare utilization. Patient- and hospital-level factors play a substantial role in shaping these outcomes. Targeted preoperative optimization and standardized perioperative management strategies for patients with MetS-OA may mitigate adverse events, enhance postoperative recovery, and reduce overall hospitalization charges.
Total knee arthroplasty (TKA) is increasingly being performed in younger adults, although most published data have focused on older populations. This study aimed to describe the clinical characteristics, etiologies, and inpatient outcomes of TKA in patients aged 18–54 years using a large national database. We performed a retrospective descriptive analysis of TKA hospitalizations in patients aged 18–54 years using the Nationwide Inpatient Sample (2016–2019). Patients were identified using ICD-10 procedural codes. Age groups were compared with respect to etiologies, demographics, comorbidities, in-hospital complications, length of stay, and total hospital charges. Statistical analyses were based on weighted frequencies, chi-square tests, and t tests. Primary osteoarthritis was the most common indication across all age groups. Patients aged 18-34.9 years had the highest proportion of Medicaid coverage and the highest proportion of post-traumatic and inflammatory etiologies. In unadjusted analyses, this youngest group also had the longest mean hospital stay and the highest mean total hospital charges, as well as higher rates of blood loss anemia and blood transfusion. In-hospital mortality was rare and did not differ significantly across age groups. In this nationwide inpatient descriptive analysis, younger adults undergoing TKA demonstrated distinct etiologic, demographic, and comorbidity profiles, with unadjusted differences in in-hospital complications and healthcare utilization across age groups. These findings should be interpreted cautiously because the study was limited to inpatient outcomes and did not include multivariable adjustment or longitudinal follow-up.
D. Maman, L. Laver, Yaniv Steinfeld et al.· Discover medicine· 0 citations
Shoulder arthroplasty is a well-established surgical intervention for osteoarthritis, rotator cuff arthropathy, and complex shoulder diseases. While effective in pain relief and functional improvement, perioperative complications remain a major concern. Patients with diabetes present metabolic disturbances and suboptimal glycemic control, conferring higher risks of adverse perioperative events. Nevertheless, evidence regarding the impact of diabetes subtypes on short-term perioperative outcomes after shoulder arthroplasty remains scarce. This study employed the U.S. National Inpatient Sample (NIS) database to explore the association between diabetes subtypes and perioperative outcomes following shoulder arthroplasty.
Data were derived from the National Inpatient Sample (NIS) database from 2016 to 2022. Patients undergoing shoulder arthroplasty were included and classified into three groups: patients with type 1 diabetes mellitus (T1DM), patients with type 2 diabetes mellitus (T2DM), and patients without diabetes. Patient demographics, hospital characteristics, surgical parameters, comorbidities, perioperative complications, and postoperative outcomes were assessed. Propensity score matching was applied to balance baseline characteristics between groups. Regression analyses were conducted to evaluate postoperative outcomes among patients with different DM subtypes.
A total of 137,651 shoulder arthroplasty cases were identified, comprising 107,388 patients without diabetes, 376 patients with type 1 DM, and 29,887 patients with type 2 DM. Following propensity score matching, multivariate analysis demonstrated no significant between-group differences in most medical and surgical complications when comparing patients without diabetes and patients with type 1 DM. In contrast, type 2 DM was identified as an independent risk factor for pneumonia/acute respiratory failure (OR = 1.19,
P
< 0.001), surgical site/periprosthetic joint infection (OR = 1.25), urinary tract infection (OR = 1.25), acute renal failure (OR = 1.53), non-routine discharge (OR = 1.34), prolonged length of stay (GMR = 1.04), and increased total hospital charges (GMR = 1.02).
Compared with patients without diabetes, patients with type 2 DM undergoing shoulder arthroplasty exhibited higher risks of several adverse in-hospital outcomes, whereas most outcomes in patients with type 1 DM were not significantly different. These findings may facilitate improved risk stratification and tailored perioperative management.
Ke-Nan Sun, Liu Yang, Lei-Ying Fan et al.· Frontiers in Medicine· 0 citations
Background: Knee osteoarthritis (OA) is a leading cause of chronic pain and functional disability, disproportionately affecting elderly individuals in low- and middle-income countries. Total knee arthroplasty (TKA) is the definitive treatment for end-stage disease, yet outcome data from tertiary care hospitals in Uttar Pradesh using validated scoring tools remain limited. Objectives were to assess the preoperative and postoperative functional outcomes of patients undergoing primary TKA using the Knee Society Score (KSS), and to examine associations between functional outcome and patient-level demographic variables.
Methods: A hospital-based prospective observational study was conducted in the Department of Orthopaedic Surgery, Balrampur Hospital, Lucknow, from September 2024 to August 2025. Sixty-five consecutive patients with primary knee OA undergoing primary TKA were enrolled. Patients with inflammatory or post-traumatic arthritis, revision surgery, active infection, or neuromuscular disorders were excluded. Functional outcome was assessed using the two-component KSS (Knee score and functional score) preoperatively and at 12-month follow-up. Preoperative-postoperative comparison was performed using paired t-test; associations between functional outcome category and demographic variables were assessed using the chi-square test (p<0.05 considered significant).
Results: Mean patient age was in the sixth decade, with female predominance (63.1%). The mean Knee Score improved from 41.6±8.9 preoperatively to 86.9±6.7 at 12 months (mean difference 45.3; p<0.001), and the mean functional score from 38.2±9.4 to 82.4±7.9 (mean difference 44.2; p<0.001). Excellent outcomes were achieved in 73.8% of patients and good outcomes in 18.5%, yielding a combined excellent-to-good rate of 92.3%. Patients aged ≥60 years demonstrated significantly better functional outcomes than younger patients (p=0.024). Gender and body mass index did not independently influence postoperative functional scores. No cases of deep infection or revision surgery were recorded during follow-up.
Conclusions: Primary TKA produces significant, sustained improvement in knee function and mobility at one year, achieving excellent-to-good outcomes in over 90% of patients. The KSS is a reliable and responsive instrument for routine outcome audit. Appropriate patient selection, structured rehabilitation, and targeted expectation management-particularly in younger patients-are key determinants of optimised postoperative results.
A. Yadav, S. Yadav, A. K. Yadav· International Journal of Res...· 0 citations
Background Total Knee arthroplasty (TKA) is an effective treatment for end-stage knee osteoarthritis (KOA), but healthcare resource utilization has become an increasing concern in an aging surgical population. Hospital Frailty Risk Score (HFRS) has been associated with adverse surgical outcomes, but its impact on resource utilization after TKA remains unclear. Using a large national database, this study aims to evaluate the association between HFRS-defined frailty risk categories and healthcare resource utilization after TKA, including length of stay (LOS), total charges (TOTCHG), and non-routine discharge. Methods Data on patients undergoing TKA were extracted from the National Inpatient Sample database. Patients were categorized into an analytic cohort and a validation cohort. We used the HFRS to identify frailty: low frailty risk (HFRS < 5), intermediate frailty risk (5–15), and high frailty risk (HFRS > 15). Patient demographic, hospital characteristics, and comorbidities were assessed. Logistic regression analyses, stratified analyses, ROC curve analyses, and sensitivity analyses were performed to evaluate associations, subgroup consistency, and discriminative performance. Results A total of 622,574 patients undergoing TKA for primary KOA were identified. Patients were categorized into low (n = 439,343), intermediate (n = 29,637), and high (n = 223) frailty risk groups according to the HFRS. In multivariable logistic regression analyses, higher HFRS-defined frailty risk categories were independently associated with increased healthcare resource utilization and complications. Compared with patients with low frailty risk, those with intermediate and high frailty risk had significantly higher odds of prolonged LOS, increased TOTCHG, non-routine discharge, any complication, and major complications (all P < 0.001). Sensitivity analyses using a binary classification of HFRS-defined frailty yielded consistent findings. Conclusion HFRS-defined frailty risk categories are independently associated with increased healthcare resource utilization and postoperative complications after TKA. These findings support the potential utility of HFRS for preoperative risk stratification and individualized perioperative care planning.
Lin-Jia Li, Zhi-han Wang, Yuan Wu et al.· Journal of Orthopaedic Surge...· 0 citations
As populations age, the number of older patients undergoing knee arthroplasty continues to increase. Cognitive impairment is prevalent among older adults and has been associated with adverse perioperative outcomes; however, its impact on postoperative delirium and discharge disposition following knee arthroplasty remains insufficiently defined, particularly in large Asian populations. We conducted a nationwide retrospective cohort study using Japan’s Diagnosis Procedure Combination database from April 2016 to March 2023. Older patients who underwent primary total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) were identified. Cognitive impairment was defined using ICD-10 diagnostic codes at admission. The primary outcome was postoperative delirium, and secondary outcomes included discharge to home, length of hospital stay, and perioperative blood transfusion. Propensity score matching (1:1) was performed to adjust for demographic factors, comorbidities, and surgical characteristics. Multivariable logistic regression and sensitivity analyses were conducted. Among 259,319 eligible patients, 3,934 matched pairs were identified after propensity score matching. Patients with cognitive impairment had a significantly higher risk of postoperative delirium compared with those without cognitive impairment (absolute risk difference, 3.2%; 95% CI, 2.5–3.9). Cognitive impairment was independently associated with postoperative delirium (odds ratio [OR], 4.47; 95% CI, 3.11–6.41) and a reduced likelihood of direct discharge to home (OR, 0.64; 95% CI, 0.57–0.71). Length of hospital stay was modestly longer in patients with cognitive impairment, whereas no clinically meaningful differences were observed in other postoperative complications after adjustment. Cognitive impairment is a strong and independent risk factor for postoperative delirium and reduced likelihood of direct discharge to home following knee arthroplasty in older patients. Incorporating cognitive assessment into perioperative risk stratification may help optimize geriatric orthopedic care and postoperative planning.
Yuri Mori, K. Tarasawa, Hidetatsu Tanaka et al.· Archives of Orthopaedic and...· 0 citations
This systematic review and meta-analysis evaluated preoperative patient factors associated with adverse outcomes after primary total knee arthroplasty (TKA). PubMed and Crossref were searched from 2010 to 2025 according to PRISMA guidance, and the protocol was registered in PROSPERO (CRD420261297849). Eligible studies included adults undergoing primary TKA and reported diabetes mellitus, hypertension, obesity, morbid obesity, or sex in relation to readmission, revision surgery, or deep infection. Random-effects generic inverse variance meta-analyses were performed using odds ratios from adjusted models when available; unadjusted or calculated estimates were used only when adjusted estimates were unavailable. Twelve cohort studies including 1,586,680 patients were included. Diabetes mellitus was associated with higher odds of readmission (OR 1.17, 95% CI 1.05-1.30) and revision surgery (OR 1.17, 95% CI 1.03-1.32). Morbid obesity (BMI ≥40 kg/m²) was associated with readmission, revision surgery, and deep infection. Male sex was associated with readmission and revision surgery, while non-morbid obesity and hypertension were not consistently associated with adverse outcomes. These findings support preoperative risk stratification and optimization for diabetes and morbid obesity before elective TKA. Interpretation should remain cautious because included studies were observational and heterogeneity was substantial in several analyses.
S. Almasoud, S. A. Alhassan, A. Alwusaibie et al.· Annals of Middle Eastern Med...· 0 citations
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