Increased risk of deep vein thrombosis and surgical site infection in cemented total knee arthroplasty: A nationwide propensity score-matched study in Japan.

INTRODUCTION

Total knee arthroplasty (TKA) is a widely used treatment for advanced knee osteoarthritis. While cemented fixation is the standard technique, cementless fixation has demonstrated comparable long-term outcomes. However, the association between cement use and postoperative complications, including venous thromboembolism and surgical site infections, remains unclear, particularly in Japanese patients. This study aimed to investigate the incidence of postoperative complications in cemented and cementless TKA using a nationwide database.

METHODS

A nationwide cohort study was conducted using Japan's DPC database from April 2016 to March 2023. Patients who underwent TKA were identified, and postoperative complications, including deep vein thrombosis, pulmonary embolism, pneumonia, cerebrovascular events, postoperative cognitive dysfunction, and surgical site infection, were analyzed. One-to-one propensity score (PS) matching was performed based on age, sex, body mass index, type of anesthesia, simultaneous bilateral surgery, Charlson comorbidity index, and comorbidities to ensure comparability. Statistical analyses included χ² tests, Student's t-tests, and multivariate logistic regression analysis.

RESULTS

A total of 228,595 patients met the eligibility criteria, with 21,906 matched pairs in the cemented and cementless groups after PS matching. The incidence of deep vein thrombosis (OR: 1.231, 95% CI: 1.151-1.316, p < 0.0001) and surgical site infection (OR: 1.716, 95% CI: 1.420-2.073, p < 0.0001) was significantly higher in the cemented group. No significant differences were observed in pulmonary embolism or other complications.

CONCLUSION

Cement application was associated with an increased risk of deep vein thrombosis and surgical site infection. These findings suggest that careful perioperative management may be warranted in patients undergoing cemented TKA.