Ibaseta Alvaro, Emara Ahmed K, Jevnikar Benjamin E, Khan Shujaa T, Pasqualini Ignacio, Turan Oguz, Adult Reconstruction Research Cleveland Clinic, Piuzzi Nicolas S
Cleveland Clinic, Cleveland, USA.
University of Cincinnati College of Medicine, Cincinnati, USA.
Eur J Orthop Surg Traumatol. 2025 Aug 4;35(1):339. doi: 10.1007/s00590-025-04418-x.
Osteoporosis is a well-recognized risk factor for complications after total knee arthroplasty (TKA). However, the effect of pre-TKA osteoporosis on healthcare utilization and patient-reported outcomes is poorly understood. Here, we characterize the association between pre-TKA osteoporosis and (1) healthcare utilization and patient-reported pain and function outcome measures; and (2) dual X-ray absorptiometry (DEXA) scan T-scores and the aforementioned outcomes.
A prospective cohort of primary elective TKA patients between July 2015 and January 2020 was obtained (n = 6318), of which 4922 (77.9%) completed 1-year follow-up. Outcomes included healthcare utilization (prolonged length of stay (LOS) ≥ 3D, discharge disposition (DD), 90-day readmission, and 1-year reoperation) as well as Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain, KOOS-function (PS) and satisfaction.
The prevalence of pre-TKA osteoporosis was 66.8%, of which 28.7% had a DEXA scan and 66.3% were on osteoporosis medications. Medicated osteoporotic patients were independently associated with higher odds of prolonged LOS (Odds Ratio (OR): 1.21 (95% Confidence Interval (CI) 1.02-1.43)) and non-home DD (OR:1.56 (95%CI 1.25-1.95)). Medicated and non-medicated osteoporosis patients were associated with higher odds of 90-day readmission. The odds of failing to achieve MCID or satisfaction were not associated with preoperative OP diagnosis.
Two-thirds of primary TKA recipients had osteoporosis. Among these patients, two-thirds were on medication and one-third had a DEXA scan. Osteoporotic patients are at a higher risk of 90-day hospital readmission, longer hospital stays and non-home discharge. Interestingly, osteoporosis status was not associated with failure to achieve clinically significant improvements or satisfaction at 1 year following TKA.
骨质疏松是全膝关节置换术（TKA）后并发症的一个公认风险因素。然而，TKA术前骨质疏松对医疗资源利用和患者报告结局的影响尚不清楚。在此，我们描述TKA术前骨质疏松与（1）医疗资源利用以及患者报告的疼痛和功能结局指标之间的关联；以及（2）双能X线吸收法（DEXA）扫描T值与上述结局之间的关联。
获取了2015年7月至2020年1月期间接受初次择期TKA患者的前瞻性队列（n = 6318），其中4922例（77.9%）完成了1年随访。结局包括医疗资源利用（住院时间延长（LOS）≥3天、出院处置（DD）、90天再入院和1年再次手术）以及膝关节损伤和骨关节炎结局评分（KOOS）疼痛、KOOS功能（PS）和满意度。
TKA术前骨质疏松的患病率为66.8%，其中28.7%进行了DEXA扫描，66.3%正在接受骨质疏松药物治疗。接受药物治疗的骨质疏松患者与住院时间延长的较高几率独立相关（比值比（OR）：1.21（95%置信区间（CI）1.02 - 1.43））和非居家出院（OR：1.56（95%CI 1.25 - 1.95））。接受药物治疗和未接受药物治疗的骨质疏松患者与90天再入院的较高几率相关。未达到最小临床重要差异（MCID）或满意度的几率与术前骨质疏松诊断无关。
三分之二的初次TKA患者患有骨质疏松。在这些患者中，三分之二正在接受药物治疗，三分之一进行了DEXA扫描。骨质疏松患者90天再次入院、住院时间延长和非居家出院的风险较高。有趣的是，骨质疏松状态与TKA术后1年未实现临床显著改善或满意度无关。
