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Increased Rate of Complications Following Total Knee Arthroplasty in Patients Who Have Marfan Syndrome
Zhichang Zhang1, Elizabeth Driskill2, Jialun Chi2
1Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia; Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China.
Background:
Outcomes of Marfan syndrome (MFS) patients after total knee arthroplasty (TKA) are poorly documented in the literature. The purpose of this study was to evaluate MFS as a potential risk factor for complications after TKA.
Methods:
Using a national private payer insurance database from 2010 to 2022, MFS patients undergoing primary TKA were identified and compared to 10:1 matched controls based on age, sex, obesity, diabetes mellitus, and a comorbidity index. A total of 4,092 patients undergoing primary TKA were analyzed, of which 372 had MFS. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to 2 years. 90-day emergency department-visits and inpatient readmissions were also documented.
Results:
Compared to the matched controls, patients who have MFS displayed elevated rates of surgical complications, including prosthetic instability (1-year, odds ratio (OR) 3.88, 95% confidence interval (CI) [1.58 to 8.66]; 2-year, OR 4.39, 95% CI [2.16 to 8.44]), and revision surgery (2 year, OR 1.79, 95% CI [1.05 to 2.91]). Additionally, patients who have MFS demonstrated significant higher rates of medical complications, including aortic dissection (2.15 versus 0%) and transfusion (OR 2.63, 95% CI [1.31 to 4.90]).
Conclusions:
Patients who have MFS are at higher risks of postoperative complications after TKA, encompassing both medical and surgical complications. Specifically, patients who have MFS have a significantly higher likelihood of experiencing prosthetic instability and requiring revision surgery. Given these results, it is crucial for orthopedic surgeons and patients alike to consider these risks when determining a course of TKA for patients who have MFS.
Insights
Patients with Marfan syndrome (MFS) face higher risks of surgical and medical complications, including prosthetic instability and aortic dissection, after total knee arthroplasty (TKA). These findings highlight the need for careful consideration of TKA risks in MFS patients.
Area of Science:
- Orthopedic Surgery
- Genetics
- Medical Complications
Background:
- Outcomes for Marfan syndrome (MFS) patients undergoing total knee arthroplasty (TKA) are not well-documented.
- MFS may increase the risk of complications after TKA.
Purpose of the Study:
- To evaluate Marfan syndrome as a risk factor for complications following total knee arthroplasty.
- To compare TKA outcomes in MFS patients versus matched controls.
Main Methods:
- A national private payer insurance database (2010-2022) was used to identify MFS patients undergoing primary TKA.
- MFS patients were matched 1:10 with controls based on age, sex, obesity, diabetes, and comorbidity index.
- Multivariable logistic regression analyzed medical (90-day) and surgical (2-year) complications, including revision surgery and prosthetic instability.
Main Results:
- MFS patients showed higher rates of prosthetic instability (2-year OR 4.39) and revision surgery (2-year OR 1.79).
- Significant increases in medical complications were observed, including aortic dissection (2.15% vs 0%) and transfusion (OR 2.63).
- MFS patients had higher 90-day emergency department visits and readmissions.
Conclusions:
- Marfan syndrome patients face elevated risks of both medical and surgical complications after TKA.
- Prosthetic instability and the need for revision surgery are significantly more likely in MFS patients.
- Orthopedic surgeons and patients should carefully weigh these increased risks when considering TKA for individuals with MFS.
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