免疫性血小板减少性紫癜作为全膝关节置换术后并发症的预测指标：一项全国性队列研究。
Immune thrombocytopenic purpura as a predictor of postoperative complications in total knee arthroplasty: A nationwide cohort study.
作者信息
Areti Aruni S, Gudmundsson Paul, Perake Vinayak, Sambandam Senthil N
机构信息
Baylor College of Medicine, 1 Baylor Plz, Houston, TX, 77030, USA.
UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
出版信息
J Orthop. 2025 May 27;68:137-142. doi: 10.1016/j.jor.2025.05.041. eCollection 2025 Oct.
BACKGROUND
Total knee arthroplasty (TKA) is one of the most common joint replacement procedures in the United States, with increasing use among medically complex populations. Immune thrombocytopenic purpura (ITP), a rare autoimmune disorder marked by low platelet counts, may increase the risk of adverse postoperative outcomes.
METHODS
We conducted a retrospective cohort study using the TriNetX Research Network, which includes de-identified electronic health records from over 74 million U.S. patients. Patients undergoing primary total knee arthroplasty (TKA) between 2005 and 2023 were identified using CPT code 27447. Immune thrombocytopenic purpura (ITP) was defined using ICD-9 code 287.3 and ICD-10 code D69.3 within one year prior to surgery. ITP patients were compared to non-ITP controls before and after 1:1 propensity score matching. Postoperative complications were identified using ICD codes. Odds ratios (ORs) and 95 % confidence intervals (CIs) were reported; p < 0.05 was considered significant.
RESULTS
We identified 3817 ITP patients and 233,543 non-ITP controls, with 3817 matched pairs in the final analysis. ITP was associated with increased odds of several postoperative complications. Infectious outcomes included higher rates of wound dehiscence (OR = 2.77), periprosthetic joint infection (OR = 5.40), and pneumonia (OR = 2.44) (all p < 0.001); deep surgical site infection was elevated pre-matching. Hematologic and cardiovascular complications included blood loss anemia (OR = 2.58), acute renal failure (OR = 2.67), and myocardial infarction (OR = 4.20). VTE events were more common, including deep vein thrombosis (OR = 2.44) and pulmonary embolism (OR = 2.90). Mechanical complications included periprosthetic fracture (OR = 3.18) and mechanical failure (OR = 4.20) (all p ≤ 0.002).
CONCLUSION
ITP was a significant risk factor for complications following TKA, underscoring the need for preoperative risk stratification and tailored perioperative management in this high-risk population.
背景
全膝关节置换术（TKA）是美国最常见的关节置换手术之一，在病情复杂的人群中应用越来越多。免疫性血小板减少性紫癜（ITP）是一种罕见的自身免疫性疾病，其特征为血小板计数低，可能会增加术后不良结局的风险。
方法
我们使用TriNetX研究网络进行了一项回顾性队列研究，该网络包含来自超过7400万美国患者的去识别化电子健康记录。使用CPT代码27447识别2005年至2023年间接受初次全膝关节置换术（TKA）的患者。免疫性血小板减少性紫癜（ITP）在手术前一年内使用ICD-9代码287.3和ICD-10代码D69.3进行定义。在1:1倾向评分匹配前后，将ITP患者与非ITP对照进行比较。使用ICD代码识别术后并发症。报告比值比（OR）和95%置信区间（CI）；p<0.05被认为具有统计学意义。
结果
我们识别出3817例ITP患者和233543例非ITP对照，最终分析中有3817对匹配病例。ITP与几种术后并发症的发生几率增加相关。感染性结局包括伤口裂开发生率较高（OR=2.77）、假体周围关节感染（OR=5.40）和肺炎（OR=2.44）（均p<0.001）；术前匹配时深部手术部位感染率升高。血液学和心血管并发症包括失血性贫血（OR=2.58）、急性肾衰竭（OR=2.67）和心肌梗死（OR=4.20）。静脉血栓栓塞事件更常见，包括深静脉血栓形成（OR=2.44）和肺栓塞（OR=2.90）。机械并发症包括假体周围骨折（OR=3.18）和机械故障（OR=4.20）（均p≤0.002）。
结论
ITP是TKA术后并发症的一个重要危险因素，强调了在这一高危人群中进行术前风险分层和定制围手术期管理的必要性。
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