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      Comparison of Postoperative Outcomes of Patients Undergoing Total Hip and Total Knee Arthroplasty Following a Diagnosis of Dementia: A TriNetX Database Study

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          Abstract

          Background

          As life expectancy improves for patients with dementia, the demand for mobility-improving surgeries such as total joint arthroplasty (TJA) will increase. There is little research on patients with dementia undergoing TJA, although dementia has been shown to be a risk factor for complications. The purpose of this study is to compare postoperative outcomes of patients with dementia undergoing TJA at 90 days, 2 years, and 5 years.

          Methods

          The TriNetX database was retrospectively queried for all patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients were divided into cohorts by preoperative diagnosis of dementia and propensity score matched. The following outcomes were evaluated between groups at 90 days, 2 years, and 5 years postoperatively: revision, resection arthroplasty, closed reduction (THA only), femur fracture plating, and prosthetic joint infection. Readmission and manipulation under anesthesia (TKA only) were evaluated at 90 days postoperatively. Univariate and multivariate analyses were performed.

          Results

          After matching, there were no differences in demographics or comorbidities between groups. TKA (odds ratio [OR] = 1.75, 95% confidence interval [CI] 1.42-2.15, P < .001) and THA (OR = 2.17, 95% CI 1.92-2.45, P < .001) patients with dementia were more likely to be readmitted than patients without dementia. At 2 years (OR = 2.07, 95% CI 1.14-3.77, P = .015) and 5 years (OR = 2.14, 95% CI 1.32-3.48, P = .002) postoperatively, THA patients with dementia were more likely to have proximal femur fracture plating than patients without dementia.

          Conclusions

          Patients undergoing THA with dementia had worse outcomes than patients undergoing THA without dementia and TKA with dementia. The overall rate of complications was low, and a diagnosis of dementia should not be an absolute contraindication to proceeding with TJA.

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          Most cited references31

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          Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030

          Steven Kurtz, Kevin Ong, Edmund Lau … (2007)
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            Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030

            Matthew Sloan, Ajay Premkumar, Neil Sheth (2018)
            The volume of primary total joint arthroplasty (TJA) procedures has risen in recent decades. However, recent procedure growth has not been at previously projected exponential rates. To anticipate the future expense of TJA, updated models are necessary to predict TJA volume in the U.S.
            Article 0 comments Cited 421 times – based on 0 reviews     Review now
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              Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register

              Nils Hailer, Göran Garellick, Johan Kärrholm (2010)
              Background and purpose Since the introduction of total hip arthroplasty (THA) in Sweden, both components have most commonly been cemented. A decade ago the frequency of uncemented fixation started to increase, and this change in practice has continued. We therefore analyzed implant survival of cemented and uncemented THA, and whether the modes of failure differ between the two methods of fixation. Patients and methods All patients registered in the Swedish Hip Arthroplasty Register between 1992 and 2007 who received either totally cemented or totally uncemented THA were identified (n = 170,413). Kaplan-Meier survival analysis with revision of any component, and for any reason, as the endpoints was performed. Cox regression models were used to calculate risk ratios (RRs) for revision for various reasons, adjusted for sex, age, and primary diagnosis. Results Revision-free 10-year survival of uncemented THA was lower than that of cemented THA (85% vs. 94%, p < 0.001). No age or diagnosis groups benefited from the use of uncemented fixation. Cox regression analysis confirmed that uncemented THA had a higher risk of revision for any reason (RR = 1.5, 95% CI: 1.4–1.6) and for aseptic loosening (RR = 1.5, CI: 1.3–1.6). Uncemented cup components had a higher risk of cup revision due to aseptic loosening (RR = 1.8, CI: 1.6–2.0), whereas uncemented stem components had a lower risk of stem revision due to aseptic loosening (RR = 0.4, CI: 0.3–0.5) when compared to cemented components. Uncemented stems were more frequently revised due to periprosthetic fracture during the first 2 postoperative years than cemented stems (RR = 8, CI: 5–14). The 5 most common uncemented cups had no increased risk of revision for any reason when compared with the 5 most commonly used cemented cups (RR = 0.9, CI: 0.6–1.1). There was no significant difference in the risk of revision due to infection between cemented and uncemented THA. Interpretation Survival of uncemented THA is inferior to that of cemented THA, and this appears to be mainly related to poorer performance of uncemented cups. Uncemented stems perform better than cemented stems; however, unrecognized intraoperative femoral fractures may be an important reason for early failure of uncemented stems. The risk of revision of the most common uncemented cup designs is similar to that of cemented cups, indicating that some of the problems with uncemented cup fixation may have been solved.
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                Author and article information

                Contributors
                Justin J. Turcotte
                Journal
                Journal ID (nlm-ta): Arthroplast Today
                Journal ID (iso-abbrev): Arthroplast Today
                Title: Arthroplasty Today
                Publisher: Elsevier
                ISSN (Electronic): 2352-3441
                Publication date PMC-release: 29 March 2024
                Publication date Collection: June 2024
                Publication date (Electronic): 29 March 2024
                Volume: 27
                Electronic Location Identifier: 101359
                Affiliations
                [a ]Anne Arundel Medical Center, Annapolis, MD, USA
                [b ]Center for Joint Replacement, Anne Arundel Medical Center, Annapolis, MD, USA
                [c ]Orthopedic and Surgical Research, Anne Arundel Medical Center, Annapolis, MD, USA
                Author notes
                [∗ ]Corresponding author. Orthopedic Research, Anne Arundel Medical Center, 2000 Medical Parkway, Suite 503, Annapolis, MD 21401, USA. Tel.: +1 410 271 2674. jturcotte@ 123456aahs.org
                Article
                Publisher Item ID: S2352-3441(24)00044-X Publisher ID: 101359
                DOI: 10.1016/j.artd.2024.101359
                PMC ID: 10995796
                PubMed ID: 38585284
                SO-VID: b37fd8da-e152-4fbf-b7c5-e7b9b568a597
                Copyright © © 2024 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 10 November 2023
                Date revision received : 13 February 2024
                Date accepted : 21 February 2024
                Categories
                Subject: Original Research

                Keywords: total hip arthroplasty,total knee arthroplasty,dementia,postoperative complications
                Data availability:
                Keywords: total hip arthroplasty, total knee arthroplasty, dementia, postoperative complications

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