Outcomes After Total Knee Arthroplasty in Patients With Autism: A Retrospective Database Study

Area of Science:

• Orthopedic surgery
• Neurodevelopmental disorders
• Patient safety

Background:

• Osteoarthritis is a common condition necessitating total knee arthroplasty (TKA).
• Autism spectrum disorder (ASD) is a neurodevelopmental condition; its impact on TKA outcomes was previously unclear.

Purpose of the Study:

• To investigate the safety and efficacy of TKA in patients with ASD.
• To compare adverse event rates and long-term implant survival between TKA patients with and without ASD.

Main Methods:

• Retrospective analysis of TKA patients from the M157 PearlDiver database.
• Matched 1:4 cohort study comparing ASD patients with controls based on age, sex, and Elixhauser Comorbidity Index (ECI).
• Multivariable regression for 90-day adverse events and Kaplan-Meier analysis for 5-year revision rates.

Main Results:

• ASD patients were younger and had higher ECIs than controls.
• Patients with ASD exhibited significantly higher odds of 90-day adverse events, particularly sepsis, pneumonia, and urinary tract infections.
• No significant difference in 5-year revision rates was observed between the ASD and control groups.

Conclusions:

• TKA patients with ASD face elevated risks for certain infectious complications, necessitating enhanced perioperative care.
• Despite increased infection risks, TKA demonstrates comparable long-term implant survival in ASD patients.
• Patients with ASD can be considered for TKA, provided appropriate precautions are implemented.