Immune thrombocytopenic purpura as a predictor of postoperative complications in total knee arthroplasty: A nationwide cohort study

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-05-27 DOI:10.1016/j.jor.2025.05.041

Aruni S. Areti , Paul Gudmundsson , Vinayak Perake , Senthil N. Sambandam

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引用次数: 0

Abstract

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.

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免疫性血小板减少性紫癜作为全膝关节置换术术后并发症的预测因子：一项全国性队列研究

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，在医学复杂人群中的应用越来越多。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，以血小板计数低为特征，可能增加术后不良结果的风险。方法：我们使用TriNetX研究网络进行了一项回顾性队列研究，其中包括来自7400多万美国患者的去识别电子健康记录。2005年至2023年间接受原发性全膝关节置换术（TKA）的患者使用CPT代码27447进行鉴定。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对照组进行比较。使用ICD代码识别术后并发症。报告了优势比（ORs）和95%置信区间（ci）；p & lt;0.05被认为是显著的。结果我们鉴定了3817例ITP患者和233543例非ITP对照组，在最终分析中有3817对配对。ITP与几种术后并发症的发生率增加有关。感染结局包括较高的伤口裂开（OR = 2.77）、假体周围关节感染（OR = 5.40）和肺炎（OR = 2.44）(均p <；0.001);术前深部手术部位感染升高。血液学和心血管并发症包括失血性贫血（OR = 2.58）、急性肾功能衰竭（OR = 2.67）和心肌梗死（OR = 4.20）。VTE事件更为常见，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）和机械失效（OR = 4.20）（均p≤0.002）。结论itp是TKA术后并发症的重要危险因素，需要对这一高危人群进行术前风险分层和围手术期管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.