Department of Orthopedic Research, Holy Cross Hospital, Orthopedic Research Institute, Fort Lauderdale, FL.
Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL.
J Arthroplasty. 2020 Jan;35(1):95-99. doi: 10.1016/j.arth.2019.08.025. Epub 2019 Aug 16.
Research regarding the impact of hypogonadism following primary total knee arthroplasty (TKA) is limited. Therefore, the purpose of this study is to investigate whether patients with hypogonadism undergoing primary TKA are at increased odds of (1) medical complications, (2) revisions, (3) in-hospital lengths of stay (LOSs), and (4) cost of care.
A Humana patient population consisting of 8 million lives was retrospectively analyzed from 2007 to 2017 using International Classification of Disease, 9th Revision codes. Patients were filtered by male gender and patients with hypogonadism were matched to controls in a 1:4 ratio according to age and medical comorbidities. The query yielded 8393 patients with (n = 1681) and without (6712) hypogonadism undergoing primary TKA. Primary outcomes analyzed included medical complications, revision rates, in-hospital LOS, and cost of care. Logistic regression analysis was used to calculate odds ratios (OR) of 90-day medical complications and 2-year revisions. Welch's t-test was used to test for significance in LOS and cost of care between cohorts. A P-value less than .05 was considered statistically significant.
Hypogonadal patients undergoing primary TKA were found to have increased incidence and odds (9.45% vs 4.67%; OR 2.12, P < .0001) of developing 90-day medical complications. Hypogonadal patients undergoing primary TKA were found to have a greater incidence and odds (3.99% vs 2.80%; OR 1.89, P < .0001) of 2-year revisions. Hypogonadal patients had a 6.11% longer LOS (3.47 vs 3.27 days, P = .02) compared to controls, and incurred greater 90-day costs ($15,564.31 vs $14,856.69, P = .018) compared to controls.
This analysis of over 1600 patients demonstrates that patients with hypogonadism undergoing primary TKA have greater odds of postoperative medical complications, revisions, increased LOS, and cost of care.
关于原发性全膝关节置换术后性腺功能减退症影响的研究有限。因此，本研究的目的是探讨原发性全膝关节置换术后性腺功能减退症患者是否存在以下风险增加的可能性：（1）医疗并发症，（2）翻修，（3）住院时间（LOS），以及（4）治疗费用。
利用国际疾病分类第 9 版代码，回顾性分析了 2007 年至 2017 年期间 Humana 患者数据库中的 800 万例患者。通过男性性别筛选出患者，并根据年龄和医疗合并症，将性腺功能减退症患者与对照组以 1:4 的比例匹配。该查询得出了 8393 名接受原发性全膝关节置换术的患者（n=1681）和未接受的患者（6712 名）。分析的主要结果包括医疗并发症、翻修率、住院 LOS 和治疗费用。使用逻辑回归分析计算 90 天内医疗并发症和 2 年翻修的优势比（OR）。使用 Welch 检验比较两组间 LOS 和治疗费用的差异。P 值小于 0.05 被认为具有统计学意义。
接受原发性全膝关节置换术的性腺功能减退症患者发生 90 天内医疗并发症的发生率和几率（9.45%比 4.67%；OR 2.12，P < 0.0001）更高。接受原发性全膝关节置换术的性腺功能减退症患者 2 年内翻修的发生率和几率（3.99%比 2.80%；OR 1.89，P < 0.0001）更高。与对照组相比，性腺功能减退症患者的 LOS 延长了 6.11%（3.47 天比 3.27 天，P=0.02），90 天的治疗费用也更高（15564.31 美元比 14856.69 美元，P=0.018）。
这项超过 1600 例患者的分析表明，接受原发性全膝关节置换术的性腺功能减退症患者发生术后医疗并发症、翻修、延长 LOS 和治疗费用增加的风险更高。
