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Total Knee Arthroplasty and Homelessness: A Database Study.

Terrul Ratcliff1,2, Anubhav Thapaliya2, Patrick Ojeaga1

  • 1Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

The Archives of Bone and Joint Surgery
|September 15, 2025
PubMed
Summary

Homeless patients undergoing total knee arthroplasty (TKA) face significantly higher risks of postoperative complications, including infections and blood loss. This highlights the need for specialized care to improve outcomes for this vulnerable group.

Keywords:
ComplicationsHomelessnessKneeTotal knee arthroplastyVulnerable populations

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Area of Science:

  • Orthopedic Surgery
  • Public Health
  • Health Disparities

Background:

  • Homelessness in the U.S. affects over 550,000 individuals, with a rising prevalence and average age.
  • This population experiences a higher burden of chronic diseases, increasing vulnerability to adverse health outcomes.
  • Total knee arthroplasty (TKA) is common, but outcomes for homeless patients warrant specific investigation due to heightened complication concerns.

Purpose of the Study:

  • To compare postoperative complication rates between homeless and non-homeless patients undergoing primary total knee arthroplasty (TKA).

Main Methods:

  • Retrospective cohort study utilizing the TriNetX Research Network database.
  • Identified 245,567 primary TKA patients (CPT 27447), categorizing 463 as homeless using ICD-9/10 codes.
  • Analyzed demographic variables and postoperative complications, calculating odds ratios (OR) and using Chi-square/Fisher's exact tests.

Main Results:

  • Homeless patients were more likely to be older, obese, diabetic, and smokers.
  • Higher rates of superficial surgical site infections (OR 7.52), prosthetic joint infections (OR 2.70), acute renal failure (OR 2.44), blood loss anemia (OR 2.25), and pulmonary embolism (OR 2.81) were observed in homeless patients.
  • Statistical significance (p<0.008) was found for all reported increased complication rates.

Conclusions:

  • Homeless patients undergoing TKA experience significantly higher risks of multiple postoperative complications compared to non-homeless individuals.
  • These findings emphasize the critical need for targeted preoperative optimization strategies.
  • Tailored postoperative care plans are essential to mitigate risks and improve surgical outcomes for this vulnerable patient population.