Chronic Oral Corticosteroid Use and 10-Year Incidence of Major Complications Following Total Knee Arthroplasty

Mark Haft; Sanjay Kubsad; John M Pirtle; Amil R Agarwal; Rachel A Ranson; Thomas Fraychineaud; James N DeBritz; Savyasachi C Thakkar; Gregory J Golladay

doi:10.1016/j.arth.2024.04.048

Chronic Oral Corticosteroid Use and 10-Year Incidence of Major Complications Following Total Knee Arthroplasty

J Arthroplasty. 2024 Apr 20:S0883-5403(24)00371-1. doi: 10.1016/j.arth.2024.04.048. Online ahead of print.

Authors

Mark Haft¹, Sanjay Kubsad², John M Pirtle³, Amil R Agarwal⁴, Rachel A Ranson⁵, Thomas Fraychineaud⁵, James N DeBritz⁵, Savyasachi C Thakkar¹, Gregory J Golladay⁶

Affiliations

¹ Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
² Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Orthopaedic Surgery, University of Washington School of Medicine, Seattle, Washington.
³ West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia.
⁴ Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
⁵ Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
⁶ Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia.

PMID: 38649066
DOI: 10.1016/j.arth.2024.04.048

Abstract

Background: Oral corticosteroids are the primary treatment for several autoimmune conditions. The risk of long-term implant, bone health, and infectious-related complications in patients taking chronic oral corticosteroids before total knee arthroplasty (TKA) is unknown. We compared the 10-year cumulative incidence of revision, periprosthetic joint infection (PJI), fragility fracture (FF), and periprosthetic fracture following TKA in patients who had and did not have preoperative chronic oral corticosteroid use.

Methods: A retrospective cohort analysis was conducted using a national database. Primary TKA patients who had chronic preoperative oral corticosteroid use were identified using Current Procedural Terminology and International Classification of Disease 9 and 10 codes. Exclusion criteria included malignancy, osteoporosis treatment, trauma, and < 2-year follow-up. Primary outcomes were 10-year cumulative incidence and hazard ratios (HRs) of all-cause revision (ACR), aseptic revision, PJI, FF, and periprosthetic fracture. A Kaplan-Meier analysis and a multivariable Cox proportional hazards model were utilized. Overall, 611,596 patients were identified, and 5,217 (0.85%) were prescribed chronic corticosteroids. There were 10,000 control patients randomly sampled for analysis.

Results: Corticosteroid patients had significantly higher 10-year HR of FF (HR; 95% confidence interval); P value (1.47; 1.34 to 1.62; P < .001)], ACR (1.21; 1.05 to 1.40; P = .009), and PJI (1.30; 1.01 to 1.69; P = .045) when compared to the control.

Conclusions: Patients prescribed preoperative chronic oral corticosteroids had higher risks of ACR, PJI, and FF within 10 years following TKA compared to patients not taking corticosteroids. This information can be used by surgeons during preoperative counseling to educate this high-risk patient population about their increased risk of postoperative complications.

Keywords: chronic corticosteroids; fragility fracture; periprosthetic fracture; prosthetic joint infection; revision; total knee arthroplasty.