Total Knee Arthroplasty in Patients with Spinal Cord Injury: Impact on Medical Complications, Hospital Costs and Length of Stay

JAAOS Glob Res Rev, 2023 · DOI: 10.5435/JAAOSGlobal-D-22-00145 · Published: April 1, 2023

Simple Explanation

This study examines the outcomes of total knee arthroplasty (TKA) in patients with spinal cord injury (SCI). It compares complication rates, length of hospital stay, and costs between SCI patients undergoing TKA and those without SCI. The study used a large national database to compare outcomes between the two groups, looking at factors like age, sex, and pre-existing conditions, as well as complications like renal failure, infections, and blood loss. The results showed that SCI patients undergoing TKA tend to be younger but have a higher risk of complications, longer hospital stays, and greater incurred charges compared to non-SCI TKA patients.

Study Duration

2016 to 2019

Participants

558,371 patients who underwent TKA; 60 with SCI and TKA (SCITKA), 558,311 with standard TKA (STKA) no SCI

Evidence Level

Retrospective study

Key Findings

1
Patients with SCI undergoing TKA have a significantly greater risk of acute renal failure compared to those without SCI.
2
SCI patients undergoing TKA experience a higher incidence of blood loss anemia compared to non-SCI TKA patients.
3
SCI patients undergoing TKA have a greater risk of local complications, including periprosthetic fracture and infection.

Research Summary

This study investigated the impact of spinal cord injury (SCI) on outcomes following total knee arthroplasty (TKA) using a large national database. The study found that SCI patients undergoing TKA are at increased risk for several complications, including acute renal failure, blood loss anemia, periprosthetic fractures and infections. SCI patients undergoing TKA also experienced longer hospital stays and incurred greater charges compared to non-SCI TKA patients, highlighting the need for careful management and resource allocation.

Practical Implications

Preoperative Risk Assessment

Surgeons should carefully assess the increased risk of complications in SCI patients undergoing TKA and optimize their preoperative condition.

Postoperative Management

A multidisciplinary team approach is crucial for managing the increased medical and surgical complications in SCI patients after TKA.

Informed Consent

Patients with SCI should be informed about the increased risks, potential for longer hospital stays, and higher costs associated with TKA.

Study Limitations

1
Retrospective data collection using ICD codes leads to loss of granularity of information.
2
Accuracy of data depends on the ability of the database to correctly translate clinical information.
3
Only 20% of hospitals in the United States were represented in the NIS database.

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