10-Year Cumulative Incidence and Indications for Revision Total Knee Arthroplasty Among Patients Who Have Sickle Cell Disease |
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| Affiliation: | 1. Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia;2. Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;3. Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;4. Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia;1. Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh;2. Department of Orthopaedics, University of Edinburgh, Edinburgh;3. Golden Jubilee National Hospital, Glasgow;4. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow;1. Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas;2. Department of Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas;3. Arkansas Department of Health, Little Rock, Arkansas;1. Colorado Joint Replacement, Denver, Colorado;2. Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland;3. Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina;4. Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado;5. Department of Orthopaedics, University of Colorado School of Medicine, Denver, Colorado;6. Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee;1. Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania;2. Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland;3. Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland;1. Mayo Clinic, Rochester, Minnesota;2. University of Florida, Gainesville, Florida |
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| Abstract: | BackgroundLiterature regarding total knee arthroplasty (TKA) outcomes in sickle cell disease (SCD) is limited. Moreover, 10-year survivorship of SCD implants is unknown. This study aimed to observe 10-year cumulative incidence and indications for revision TKA in patients who did and did not have SCD.MethodsPatients who underwent primary TKA were identified using a large national database. The SCD patients were matched by age, sex, and a comorbidity index to a control cohort in a 1:4 ratio. The 10-year cumulative incidence rates were determined using Kaplan–Meier survival analyses. Multivariable analyses were conducted using Cox proportional hazard modeling. Chi-squared analyses were conducted to compare indications for revision between cohorts. In total, 1,010 SCD patients were identified, 100,000 patients included in the unmatched control, and 4,020 patients included in the matched control.ResultsCompared to the unmatched control cohort, SCD patients exhibited higher 10-year all-cause revision (HR: 1.86; P < .001) with higher proportions of revisions for periprosthetic joint infection (PJI) (P < .001), aseptic loosening (P < .001), and hematoma (P < .001). Compared to the matched control, SCD patients had higher 10-year all-cause revision (Hazard Ratio (HR): 1.39; P = .034) with a higher proportion of revisions for PJI (P = .044), aseptic loosening (P = .003), and hematoma (P = .019).ConclusionIndependent of other comorbidities, SCD patients are more likely to undergo revisions for PJI, aseptic loosening, and hematoma compared to patients who do not have SCD. Due to the high-risk of these complications, perioperative and postoperative surgical optimization should be enforced in SCD patients. |
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| Keywords: | sickle cell disease revision total knee arthroplasty survivorship etiology |
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