The association between losartan potassium prescription and postoperative outcomes following total knee arthroplasty: A TriNetX analysis

Background

Total knee arthroplasty (TKA) is a common surgical procedure performed to alleviate pain and improve functional outcomes in patients with knee osteoarthritis and rheumatoid arthritis who have failed conservative treatments. Arthrofibrosis has been extensively studied due to its negative impact on TKA outcomes. Losartan, an angiotensin receptor blocker (ARB), has the potential to improve TKA outcomes by inhibiting TGF-β and decreasing fibrosis. This study aims to analyze a large-scale, real-world healthcare database to investigate the association between losartan potassium prescription and postoperative outcomes such as readmissions, ED visits, and the need for MUA or revision TKA.

Hypothesis

Based on previous literature and the nature of ARBs, it is expected that the addition of losartan will aid in better outcomes for patients following a primary TKA.

Patients and methods

In this retrospective observational study, the TriNetX Research Network (TriNetX) database was queried as of June 21, 2023. All patients who underwent a primary total knee arthroplasty (TKA) prior to June 21, 2022 were included. Patients were then divided into two cohorts by whether they had an active losartan potassium prescription within the year prior to their surgery to within 90 days postoperatively. Patients were then propensity-matched to eliminate differences in demographics and comorbidities.

Results

Losartan TKA patients were 1.18 [OR: 0.85 (95% CI: 0.79–0.90), p < 0.001] times less likely to be readmitted within 90 days and were 1.15 (OR: 0.87 (95% CI: 0.79–0.96); p = 0.009) times less likely to undergo a manipulation under anesthesia (MUA) within the 1-year postoperative period. There were no statistically significant differences in rates of emergency department (ED) visits at 90 days postoperatively or revision TKAs at 1 year postoperatively.

Discussion

In conclusion, patients with an active losartan prescription prior to TKA had a significantly lower likelihood of readmission within 90 days and a lower likelihood of undergoing MUA within the 1-year postoperative period compared to patients not taking losartan. This presents an opportunity for further clinical investigation to explore the value of losartan in TKA.

Level of evidence

III; an observational cohort study.