Assessing the Impact of Peripheral Artery Disease on Total Knee Arthroplasty Outcomes

Abstract

Background

Total knee arthroplasty (TKA) is a crucial orthopaedic procedure used to relieve pain from knee joint degeneration. Concurrently, peripheral artery disease (PAD) presents a major challenge, complicating orthopaedic interventions, particularly TKA, due to its impact on vascular health. Despite advances in surgical techniques and care, patients who have PAD undergoing TKA face heightened risks. Our retrospective study aimed to assess the impact of PAD on TKA outcomes.

Methods

This retrospective cohort study drew data from a healthcare database platform from January 1, 2003, to January 1, 2024. A total of 245,954 patients aged 18 years and older who underwent primary TKA were identified using relevant Current Procedural Terminology, International Classification of Diseases, 9th Revision codes, and International Classification of Diseases, 10th Revision codes. Patients were categorized into two groups as follows: those who had PAD (+PAD) and those who did not have (-PAD). Propensity score matching was performed, resulting in 15,717 patients in each cohort. Rates of postoperative complications were assessed.

Results

Within 30 days post-TKA, patients in the +PAD cohort showed significantly higher risks of complications, including acute posthemorrhagic anemia, wound dehiscence, periprosthetic joint infection, lower extremity deep vein thrombosis, pulmonary embolism, pneumonia, acute renal failure, and death compared to patients in the -PAD cohort. Similar trends persisted at the 90-day mark, with an additional increased risk of transfusion requirement, hematoma, myocardial infarction, and periprosthetic fracture in the +PAD cohort. Furthermore, over a 2-year period, the +PAD cohort faced three times the hazards of lower extremity amputation compared to patients in the -PAD cohort.

Conclusions

Given the considerable impact of PAD on TKA outcomes, comprehensive management strategies are crucial to mitigate adverse events, underscoring the need for further research to explore risk stratification and targeted interventions for improved TKA safety in patients who have PAD.