Phase angle and extracellular edema predict risk of postoperative complications in total joint arthroplasties

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are common procedures that improve mobility but carry a risk of postoperative complications, particularly in patients with obesity. Body Mass Index (BMI) is traditionally used for risk assessment but does not account for muscle mass or fat distribution. Bioelectrical impedance analysis (BIA) provides a more detailed body composition evaluation. This study investigates the association between BIA-derived metrics and postoperative complications in TKA and THA, hypothesizing that these metrics are superior predictors compared to BMI.

A retrospective cohort study was performed on 567 adult patients who underwent primary THA or TKA from January 2020 to December 2023. The data collected included demographic characteristics, comorbidities, preoperative laboratory values, preoperative BIA measurements and postoperative complications. Multivariate logistic regression models were developed to identify independent predictors of postoperative complications. Receiver operating characteristic (ROC) curves assessed the predictive accuracy of BIA-metrics models compared to BMI model.

In a cohort of 567 patients (55.7% female, median age 66), no significant difference in BMI was found between the complication and non-complication groups. However, the complication group had a higher ECW/TBW ratio (0.396 vs. 0.393, p = 0.011), higher ECW/ICW ratio (0.657 vs. 0.647, p = 0.012), and a lower phase angle (4.65 vs. 4.80, p = 0.039). Multivariate logistic regression analysis revealed that higher standardized ECW/TBW (OR 1.65, 95% CI 1.17-2.31, p = 0.004) and ECW/ICW z-scores (OR 1.61, 95% CI 1.15-2.23, p = 0.005) were associated with increased odds of postoperative complications, while a lower phase angle was protective (OR 0.58, 95% CI 0.37-0.91, p = 0.018). ROC analysis showed moderate predictive accuracy for ECW/TBW (AUC 0.71, 95% CI 0.62-0.79), ECW/ICW (AUC 0.70, 95% CI 0.62-0.79), and phase angle (AUC 0.69, 95% CI 0.60-0.79). In contrast, BMI was not significantly associated with complications, and BMI model demonstrated inferior predictive accuracy (AUC 0.61).

ECW/TBW, ECW/ICW and phase angle are associated with postoperative complications in patients undergoing primary TKA or THA. These metrics provide better predictive accuracy than BMI enhancing preoperative risk stratification.