Elsevier

The Journal of Arthroplasty

Volume 29, Issue 9, September 2014, Pages 1842-1845
The Journal of Arthroplasty

Impact of Metabolic Syndrome on Perioperative Complication Rates After Total Joint Arthroplasty Surgery

https://doi.org/10.1016/j.arth.2014.04.009Get rights and content

Abstract

This study investigated the impact of metabolic syndrome (MetS) on perioperative and postoperative complication rates: the results of a cohort of 168 total hip and knee arthroplasties, 63 of normal weight, 105 with obesity without risk factors for metabolic syndrome and 39 with obesity and other factors that classify them with metabolic syndrome. Patients with metabolic syndrome were more likely to have complications than those without metabolic syndrome (P = 0.0156). Perioperative and postoperative complication rates for the MetS and control groups were 35.9% and 16.3%, respectively. Elevated BMI was the element of MetS that had the largest impact on post-surgical complication rates, and this was statistically significant (P = 0.0028). The presence of MetS in patients undergoing total joint arthroplasty has a significant impact on surgical complication rates. This cannot be attributed to the BMI component alone, and may help guide efforts of patient optimization prior to total joint arthroplasty.

Section snippets

Study Methods

Patients were retrospectively identified as undergoing total hip or knee arthroplasty at a single academic institution between the periods of 2000 and 2007. Patients were selected to meet International Diabetes Foundation criteria for metabolic syndrome including BMI > 30, and three of the following four conditions: elevated triglycerides, reduced HDL, hypertension, or diabetes. These identified patients were then compared with two other groups: those with a BMI > 30 without meeting the criteria

Results

There were 168 total patients assessed in the study. Sixty-three patients were of normal weight and did not have any of the criteria for MetS serving as a control group. The remaining 105 patients were classified as obese, and of the 105 obese patients, 39 of them met the criteria for metabolic syndrome. The patients without MetS were 29% male, and 71% female. The patients with MetS were 13% male, and 87% female. The mean age for patients without MetS was 59.8 years with a range of 18–87 years.

Discussion

In 2000, approximately 47 million US residents had MetS with the prevalence continuing to rise [10]. Given the increasing number of patients undergoing joint arthroplasty each year, identifying the risk factors that may increase postoperative complication rates is important. In 3,830,420 patients undergoing TKA surgery from 1990 and 2004, the prevalence of obesity nearly doubled from 4% to 7.7%, diabetes increased from 9.9% to 14.7% and hypertension rose from 35% to 53.4% respectively [11].

References (17)

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    Those with MetS and BMI >40 demonstrated the significantly lowest mean KSS (74 versus 78 for non-MetS, P = .04) and KSFS (59 versus 75, P < .001) at 5 years. MetS is an increasingly prevalent condition encountered in patients undergoing total joint arthroplasty with a reportedly increased risk of perioperative complications [10–14,16,18–20]. This study investigated the potential impact of MetS on longer-term outcomes after primary TKA.

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    In that study, there was a 4-fold increased risk of infection when BMI >40 kg/m2 compared to patient with a normal BMI. Gage et al [23] demonstrated similar findings that elevated BMI in MetS patients also appeared to significantly increase complication rates. Our results suggest an even higher risk (5-fold) of reoperation for PJI with the addition of MetS criteria to this morbidly obese classification.

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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.2014.04.009.

1

Both first authors contributed equally to the manuscript.

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