Do Patients with Paget's Disease Have Worse Outcomes following Primary Total Knee Arthroplasty?

Well-powered studies evaluating the effects of Paget's disease on patient outcomes following primary total knee arthroplasty (TKA) are limited. The objective of this study was to determine whether Paget's disease patients undergoing primary TKA have higher rates of complications. A query of an administrative database was performed identifying Paget's disease patients undergoing primary TKA as the study cohort. Patients who did not have Paget's disease served as a matching cohort. Study group patients were matched in a 1:5 ratio by age, sex, and comorbidities. The query yielded 34,284 patients in the study ( n  = 5,714) and matched ( n  = 28,570) cohorts. Outcomes analyzed included length of stay (LOS), costs of care, 90-day medical and surgical complications, and 2-year implant-related complications. Multivariate logistic regression analyses were used to calculate the odds ratios (ORs) of complications. Paget's disease patients undergoing primary TKA were found to have significantly longer in-hospital LOS (4 vs. 3 days, p  < 0.0001). Study group patients incurred significantly higher 90-day episode-of-care costs ($15,124.55 vs. $14,610.01, p  < 0.0001). Additionally, Paget's disease patients were found to have higher incidences and odds of medical/surgical (25.93 vs. 13.58%; OR: 1.64, p  < 0.0001) and implant-related complications (8.97 vs. 5.02%; OR: 1.71, p  < 0.0001). Specifically, Paget's disease patients were more likely to have periprosthetic fractures, mechanical loosening, and revision TKAs ( p  < 0.0001). This study demonstrated that Paget's disease was associated with longer in-hospital LOS, increased costs, and higher rates of complications. The study can be utilized by physicians to adequately educate patients with Paget's disease concerning potential complications following their primary TKA.
Competing Interests: T.M.S. reports other from AAHKS social media, other from TJO, Smith & Nephew, Hereaus, Next Science, other from Zimmer Biomet, KCl, Reflexion Health, other from Depuy, Stryker, Exactech, outside the submitted work. M.P.B. reports other from TJO, Zimmer Biomet, other from Amedica, other from Depuy, Synthes, Exactech, PCORI, Stryker, Smith & Nephew, DJO, EOA, AAHKS, AAOS, JOA, JSOA, Arthroplasty Today, outside the submitted work. M.A.M. reports other from Microport, Stryker, other from Merz, Medical Compression Systems, DJ Orthopaedics, J&J, OrthoSensor, Pacira, Sage products, TissueGene, U.S. Medical Innovations, DJ Orthopaedics, NIH, Ongoing Care Solutions, other from JOA, JKS, Surgical Techniques International, American Journal of Orthopedics, Orthopedics, other from AAOS, outside the submitted work. M.W.R. reports other from Stryker, Smith & Nephew, Zimmer, other from AAOS, AAHKS, outside the submitted work. All the other authors report no conflict of interest.
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