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J Knee Surg 2023; 36(01): 001-005
DOI: 10.1055/s-0041-1727180
Original Article

Do Patients with Paget's Disease Have Worse Outcomes following Primary Total Knee Arthroplasty?

Nicholas M. Hernandez
1   Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Rushabh M. Vakharia
2   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
,
Michael P. Bolognesi
3   Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
,
Michael A. Mont
4   Department of Orthopaedic Surgery, Lenox Hill Hospital at Northwell Health, New York, New York
,
Thorsten M. Seyler
3   Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
,
Martin W. Roche
5   Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida
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Abstract

Well-powered studies evaluating the effects of Paget's disease on patient outcomes following primary total knee arthroplasty (TKA) are limited. The objective of this study was to determine whether Paget's disease patients undergoing primary TKA have higher rates of complications. A query of an administrative database was performed identifying Paget's disease patients undergoing primary TKA as the study cohort. Patients who did not have Paget's disease served as a matching cohort. Study group patients were matched in a 1:5 ratio by age, sex, and comorbidities. The query yielded 34,284 patients in the study (n = 5,714) and matched (n = 28,570) cohorts. Outcomes analyzed included length of stay (LOS), costs of care, 90-day medical and surgical complications, and 2-year implant-related complications. Multivariate logistic regression analyses were used to calculate the odds ratios (ORs) of complications. Paget's disease patients undergoing primary TKA were found to have significantly longer in-hospital LOS (4 vs. 3 days, p < 0.0001). Study group patients incurred significantly higher 90-day episode-of-care costs ($15,124.55 vs. $14,610.01, p < 0.0001). Additionally, Paget's disease patients were found to have higher incidences and odds of medical/surgical (25.93 vs. 13.58%; OR: 1.64, p < 0.0001) and implant-related complications (8.97 vs. 5.02%; OR: 1.71, p < 0.0001). Specifically, Paget's disease patients were more likely to have periprosthetic fractures, mechanical loosening, and revision TKAs (p < 0.0001). This study demonstrated that Paget's disease was associated with longer in-hospital LOS, increased costs, and higher rates of complications. The study can be utilized by physicians to adequately educate patients with Paget's disease concerning potential complications following their primary TKA.

Keywords

total knee arthroplasty - Paget's disease - complications - revisions - costs

Supplementary Material



Publication History

Received: 30 September 2020

Accepted: 12 February 2021

Article published online:
14 May 2021

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