Patients With Uncontrolled Components of Metabolic Syndrome Have Increased Risk of Complications Following Total Joint Arthroplasty

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Abstract

Metabolic syndrome (MetS)–a diagnostic grouping of diabetes, dyslipidemia, hypertension, and obesity–has been indicated as a risk factor for perioperative complications following total joint arthroplasty (TJA). This study investigates the impact of MetS on perioperative complications, specifically the importance of controlling MetS components. One hundred thirty-three patients undergoing TJA with all four components of MetS were identified. They were matched one-to-one with patients without MetS. Control of diabetes, dyslipidemia, and hypertension was assessed. Thirty-five patients with MetS were found to have at least a single uncontrolled component. The complication rates were 49%, 8%, and 8% for uncontrolled MetS, controlled MetS, and no MetS, respectively. Multivariate analysis confirmed independent associations between control of MetS components and both perioperative complications and length of stay. Both surgeons and patients should be aware of the substantial risk of dangerous complications following TJA in patients with uncontrolled metabolic syndrome.

Section snippets

Methods and Materials

Following approval from the institutional review board, the joint arthroplasty database at this institution was utilized to identify those patients undergoing TJA with MetS between April 2000 and December 2007. Several authors have proposed varying definitions of this syndrome [14]. For the purpose of this study, we defined MetS as a body mass index (BMI) greater than 30 kg/m2, as well as a history of dyslipidemia, hypertension, and diabetes.

Control of MetS was assessed by preoperative blood

Results

During the period of time queried, we identified 133 patients who had all four components of MetS. These patients underwent 148 TJAs (103 primary knee, 34 primary hip, 7 revision knee, and 4 revision hip) during 136 admissions. Patients had an average age of 65 years (range: 40–86 years), average BMI of 37 kg/m2 (range: 30–70 kg/m2), and 79 (59%; 79/133) were female.

Within this group, 36 (26.5%; 36/136) patients had at least a single uncontrolled component of MetS. There were seven cases with

Discussion

Total joint arthroplasty is a successful procedure that provides significant relief and return to function for a majority of patients. Nevertheless, severe complications do occur and can require costly work-up and treatments including possible reoperations. Many of these complications–which can include PE, stroke, infection, acute renal failure, and cardiovascular events among many others–have devastating effects on the patient's outcome and general health. Over the past decades, many efforts

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    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2012.12.018.

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