Mittal Mehul M, Acevedo Katalina V, Mounasamy Varatharaj, Wukich Dane K, Modrall J Gregory, Sambandam Senthil
Department of Orthopaedics, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Orthopaedics, University of Texas Southwestern Medical Center, Dallas, Texas; Surgical Service, Dallas Veterans Affairs Medical Center, Dallas, Texas.
J Arthroplasty. 2025 Jun;40(6):1560-1566.e3. doi: 10.1016/j.arth.2024.11.047. Epub 2024 Nov 23.
Total knee arthroplasty (TKA) is a crucial orthopaedic procedure used to relieve pain from knee joint degeneration. Concurrently, peripheral artery disease (PAD) presents a major challenge, complicating orthopaedic interventions, particularly TKA, due to its impact on vascular health. Despite advances in surgical techniques and care, patients who have PAD undergoing TKA face heightened risks. Our retrospective study aimed to assess the impact of PAD on TKA outcomes.
This retrospective cohort study drew data from a healthcare database platform from January 1, 2003, to January 1, 2024. A total of 245,954 patients aged 18 years and older who underwent primary TKA were identified using relevant Current Procedural Terminology, International Classification of Diseases, 9th Revision codes, and International Classification of Diseases, 10th Revision codes. Patients were categorized into two groups as follows: those who had PAD (+PAD) and those who did not have (-PAD). Propensity score matching was performed, resulting in 15,717 patients in each cohort. Rates of postoperative complications were assessed.
Within 30 days post-TKA, patients in the +PAD cohort showed significantly higher risks of complications, including acute posthemorrhagic anemia, wound dehiscence, periprosthetic joint infection, lower extremity deep vein thrombosis, pulmonary embolism, pneumonia, acute renal failure, and death compared to patients in the -PAD cohort. Similar trends persisted at the 90-day mark, with an additional increased risk of transfusion requirement, hematoma, myocardial infarction, and periprosthetic fracture in the +PAD cohort. Furthermore, over a 2-year period, the +PAD cohort faced three times the hazards of lower extremity amputation compared to patients in the -PAD cohort.
Given the considerable impact of PAD on TKA outcomes, comprehensive management strategies are crucial to mitigate adverse events, underscoring the need for further research to explore risk stratification and targeted interventions for improved TKA safety in patients who have PAD.
全膝关节置换术（TKA）是一种用于缓解膝关节退变疼痛的关键骨科手术。同时，外周动脉疾病（PAD）带来了重大挑战，因其对血管健康的影响，使骨科干预，尤其是TKA变得复杂。尽管手术技术和护理有所进步，但接受TKA的PAD患者面临更高的风险。我们的回顾性研究旨在评估PAD对TKA结果的影响。
这项回顾性队列研究从2003年1月1日至2024年1月1日的医疗数据库平台中提取数据。使用相关的当前手术操作术语、国际疾病分类第9版编码和国际疾病分类第10版编码，确定了总共245,954名18岁及以上接受初次TKA的患者。患者分为以下两组：患有PAD的患者（+PAD）和未患有PAD的患者（-PAD）。进行倾向评分匹配，每个队列中有15,717名患者。评估术后并发症发生率。
在TKA术后30天内，与-PAD队列中的患者相比，+PAD队列中的患者出现并发症的风险显著更高，包括急性出血后贫血、伤口裂开、假体周围关节感染、下肢深静脉血栓形成、肺栓塞、肺炎、急性肾衰竭和死亡。在90天标记时也存在类似趋势，+PAD队列中输血需求、血肿、心肌梗死和假体周围骨折的风险进一步增加。此外，在两年期间，+PAD队列中下肢截肢的风险是-PAD队列中患者的三倍。
鉴于PAD对TKA结果有相当大的影响，全面的管理策略对于减轻不良事件至关重要，这突出了进一步研究以探索风险分层和针对性干预措施以提高PAD患者TKA安全性的必要性。
