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Predictors of 90-Day All-Cause Morbidity, Mortality and Poor Functional Outcome Scores Following Elective Total Knee Arthroplasty in a High-Volume Setting: A Prospective Cohort Study

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Abstract

Background

The primary objective was to ascertain the predictors of 90-day all-cause morbidity, mortality and poor functional outcome scores following primary total knee arthroplasty (TKA).

Material and Method

The study population comprised 3645 patients who underwent elective primary unilateral TKA at our institution. Demographic variables, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) grade and the Deyo–Charlson comorbidity scores were ascertained. The Functional outcomes, perioperative complications, mortality and readmission rates were monitored prospectively for 90 days and analysed. Patients were assessed twice: at baseline and at 90 days postoperatively. Odds ratio and the corresponding 95% confidence intervals were calculated to quantify the risk. A p < 0.05 for two-tailed tests were considered significant.

Result

The 90-day mortality rate was 0.08% (all males) and 3.95% of the patients experienced one or the other complications. The majority of patients reported excellent-to-poor scores at 90-day follow-up VAS (8.85 ± 1.02 vs. 2.65 ± 1.15; p < 0.0001) and KSS scores (42.96 ± 5.90 vs. 80.52 ± 4.15; p < 0.0001). The early readmission rate was 0.96%. Infection was being the primary reason. Age > 70 years; Deyo–Charlson co-morbidity score ≥ 4, ASA grade-III, Diabetes Mellitus, BMI > 35, Cardiac Issues and Male gender were significant predictors of early morbidity and mortality. Female, Deyo–Charlson comorbidity score ≥ 4, ASA grade-III, BMI > 35, Age > 75 years and poor preoperative scores were significantly associated with poor functional outcome.

Conclusion

The present study explicates the relative importance of predictors on morbidity, mortality and functional outcome. Efforts to minimize morbidity and mortality should concentrate more on elderly male patients, and those with high Deyo–Charlson comorbidity score, BMI and ASA grade.

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Authors and Affiliations

  1. Department of Knee and Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat, India

    Vikram Indrajit Shah, Kalpesh Shah, Ashish Seth, Amish Kshatriya, Jayesh Patil & Pranay Gujjar

  2. Department of Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat, India

    Javahir A. Pachore

  3. Department of Orthopaedics, NSCB Medical College, Jabalpur, Madhya Pradesh, India

    Sachin Upadhyay

  4. Department of Trauma and Joints, Shalby Hospitals, Jabalpur, Madhya Pradesh, India

    Sachin Upadhyay

  5. Shalby Hospitals, Ahmedabad, Gujarat, India

    Milan Kantesariya

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  1. Vikram Indrajit Shah
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Correspondence to Sachin Upadhyay.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical Approval

The study was approved by the Scientific Review Committee and the institutional review board of the participating Health Service. Written Informed consent (about the surgical technique, risks and potential complications) was provided according to the Declaration of Helsinki and obtained from all participating patients.

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Written informed consent was obtained prior to enrollment in the study.

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Shah, V.I., Pachore, J.A., Upadhyay, S. et al. Predictors of 90-Day All-Cause Morbidity, Mortality and Poor Functional Outcome Scores Following Elective Total Knee Arthroplasty in a High-Volume Setting: A Prospective Cohort Study. JOIO 56, 646–654 (2022). https://doi.org/10.1007/s43465-021-00559-3

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