Preoperative thrombocytopenia is associated with increased total joint arthroplasty postoperative complications

Preoperative thrombocytopenia has been linked to bleeding and infectious complications, but its short- and midterm impact on outcomes following total joint arthroplasty (TJA) remains unclear.

This study evaluates whether preoperative thrombocytopenia is independently associated with increased postoperative complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Using the TriNetX Research Network, we identified patients who underwent primary TKA or THA between 2010 and 2024 with a documented platelet count within one month prior to surgery and at least one year of follow-up. Two cohorts were formed: those with normal platelet counts (140,000-417,000/μL) and those with thrombocytopenia (<140,000/μL). Propensity-score matching (1:1) was performed and controlled for hemoglobin levels. Complications were assessed at 90-days and 1-year postoperatively.

A total of 11,985 matched patients were included (6627 TKA; 5358 THA). In the TKA cohort, thrombocytopenia was associated with higher odds of: surgical site infection (SSI) [OR: 1.46 (1.14, 1,87), P = 0.002], acute kidney injury (AKI) [OR: 1.54 (1.23, 1.89), P < 0.0001], transfusion [OR: 1.87 (1.55, 2.25), P < 0.0001), deep vein thrombosis (DVT) [OR: 1.52 (1.15, 2.01), P = 0.003], heart failure [OR: 1.27 (1.09, 1.49), P = 0.002), and 1-year periprosthetic joint infection (PJI) [OR: 1.60 (1.389, 1.98), P < 0.0001]. In the THA cohort, thrombocytopenia was associated with increased odds of SSI [OR: 1.43 (1.11, 1.84), P = 0.006], AKI [OR: 1.46 (1.19, 1.78), P < 0.0001], transfusion [OR: 1.95 (1.66, 2.28), P < 0.0001], myocardial infarction (OR: 1.45 (1.02, 2.07), P = 0.040], arrhythmia [OR 1.13 (1.01, 1.27), P = 0.029], and 1-year PJI [OR 1.42 (1.13, 1.77), P = 0.002].

Preoperative thrombocytopenia is independently associated with increased postoperative complications in TKA and THA. These findings support incorporating platelet count into preoperative risk stratification and warrant further investigation into targeted management strategies.