Thirty-day Postoperative Complications following Primary Total Knee Arthroplasty: A Retrospective Study of Incidence and Risk Factors at a Single Center in China

Background: Total knee arthroplasty (TKA) may be associated with serious complications that adversely affect outcomes and increase the likelihood of disability. However, few studies with sufficient sample size have reported postoperative complications following TKA among Chinese patients. This study aimed to evaluate complications of TKA within 30 postoperative days and to identify the related risk factors. Methods: A retrospective complication-based analysis of TKA using the arthroplasty registry between 2008 and 2013 was performed by summarizing complications of TKA within 30 postoperative days. Multivariate logistic regression was used to identify the predicting factors for complications 30 days after operation. Results: A total of 1542 patients underwent 2254 primary TKA between January 2008 and December 2013. A total of 137 complications occurred within 30 days after operation with an incidence rate of 6.1%. The incidence rate of major systemic complications within postoperative 30 days was 2.3%, with cardiovascular and respiratory complications as the most common complications. The incidence rates of deep venous thrombosis (DVT) and local complications were 2.4% and 1.0%, respectively. The 30-day postoperative mortality rate was 0.1% (3/2254). Multivariate logistic regression analyses identified body mass index (BMI) of ≥30.0 kg/m2 (odds ratio [OR]: 1.47) and age ≥80 years (OR: 1.87) as significant risk factors for postoperative systemic complications. A BMI of ≥30.0 kg/m2 was a significant risk factor for DVT (OR: 2.86) and other complications (OR: 2.11). The comorbidity of diabetes was a risk factor for postoperative mortality (OR: 19.20). Conclusions: This study highlighted complications with cardiac and respiratory origins as the most common complications within 30 postoperative days following primary TKA. The BMI of ≥30.0 kg/m2 and age ≥80 years were significant risk factors for 30-day postoperative complications.

[1]  D. Zukor,et al.  Hospital Discharge within 2 Days Following Total Hip or Knee Arthroplasty Does Not Increase Major-Complication and Readmission Rates. , 2016, The Journal of bone and joint surgery. American volume.

[2]  M. Kwasny,et al.  Perioperative Outcomes Following Unilateral Versus Bilateral Total Knee Arthroplasty. , 2015, The Journal of arthroplasty.

[3]  S. Memtsoudis,et al.  Staging Bilateral Total Knee Arthroplasty During the Same Hospitalization: The Impact of Timing. , 2015, The Journal of arthroplasty.

[4]  L. Køber,et al.  Body mass index and risk of perioperative cardiovascular adverse events and mortality in 34,744 Danish patients undergoing hip or knee replacement , 2014, Acta orthopaedica.

[5]  W. Novicoff,et al.  Age as an independent risk factor for postoperative morbidity and mortality after total joint arthroplasty in patients 90 years of age or older. , 2014, The Journal of arthroplasty.

[6]  X. Weng,et al.  Long-term follow-up of cemented fixed-bearing total knee arthroplasty in a Chinese population: a survival analysis of more than 10 years. , 2013, The Journal of arthroplasty.

[7]  Javad Parvizi,et al.  Unplanned readmission after total joint arthroplasty: rates, reasons, and risk factors. , 2013, The Journal of bone and joint surgery. American volume.

[8]  Wei Chen,et al.  Sex and Surgical Outcomes and Mortality After Primary Total Knee Arthroplasty: A Risk‐Adjusted Analysis , 2013, Arthritis care & research.

[9]  K. Issa,et al.  The Effects of Obesity and Morbid Obesity on Outcomes in TKA , 2013, The Journal of Knee Surgery.

[10]  Yan Ma,et al.  Trends in In-Hospital Major Morbidity and Mortality After Total Joint Arthroplasty: United States 1998–2008 , 2012, Anesthesia and analgesia.

[11]  S. Kurtz,et al.  Reason for Revision Influences Early Patient Outcomes After Aseptic Knee Revision , 2012, Clinical Orthopaedics and Related Research.

[12]  W. Maloney,et al.  Decreased Length of Stay After TKA Is Not Associated With Increased Readmission Rates in a National Medicare Sample , 2012, Clinical orthopaedics and related research.

[13]  Yue Li,et al.  Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991-2008. , 2011, JAMA.

[14]  M. Agreiter,et al.  Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. , 2011, The Journal of bone and joint surgery. British volume.

[15]  S. Kurtz,et al.  Effect of procedure duration on total hip arthroplasty and total knee arthroplasty survivorship in the United States Medicare population. , 2008, The Journal of arthroplasty.

[16]  J. Parvizi,et al.  In hospital complications after total joint arthroplasty. , 2008, The Journal of arthroplasty.

[17]  J. Parvizi,et al.  Periprosthetic Joint Infection: The Incidence, Timing, and Predisposing Factors , 2008, Clinical orthopaedics and related research.

[18]  Eric B. Smith,et al.  The Rise in the Incidence of Pulmonary Embolus after Joint Arthroplasty: Is Modern Imaging to Blame? , 2007, Clinical orthopaedics and related research.

[19]  J. Parvizi,et al.  Total joint arthroplasty: When do fatal or near-fatal complications occur? , 2006, The Journal of bone and joint surgery. American volume.

[20]  Robert L Kane,et al.  The functional outcomes of total knee arthroplasty. , 2005, The Journal of bone and joint surgery. American volume.

[21]  Olivier Ethgen,et al.  Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. , 2004, The Journal of bone and joint surgery. American volume.

[22]  A. Joshi,et al.  Mortality Following Primary Total Knee Arthroplasty , 2003, The Journal of bone and joint surgery. American volume.

[23]  W. Harmsen,et al.  Factors Affecting the Durability of Primary Total Knee Prostheses , 2003, The Journal of bone and joint surgery. American volume.

[24]  E. Belzile,et al.  Analysis of contributing factors influencing thromboembolic events after total knee arthroplasty. , 2017, Canadian journal of surgery. Journal canadien de chirurgie.

[25]  J. Bader,et al.  Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. , 2014, The Journal of bone and joint surgery. American volume.

[26]  Su Wei,et al.  Simultaneous versus staged bilateral total knee arthroplasty: a meta-analysis. , 2010 .

[27]  D. Larson,et al.  Surgical treatment of early wound complications following primary total knee arthroplasty. , 2009, The Journal of bone and joint surgery. American volume.