Hypothyroidism is Associated with Increased Medical and Surgical Complications Following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.

Abstract

Total joint arthroplasty (TJA) is an effective treatment for end-stage osteoarthritis. However, hypothyroidism, even in controlled cases, has been variably associated with increased postoperative complications. This meta-analysis aimed to evaluate the impact of hypothyroidism on outcomes after total hip (THA) or total knee arthroplasty (TKA). A comprehensive literature search was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines across PubMed, Embase, Web of Science, and Scopus from inception to October 2024. Studies comparing outcomes following TJA by hypothyroidism (18 studies, 4,622,479 TJAs) were included. Meta-analyses were conducted using a random-effects model in R (v4.4.2), with subgroup analysis by TKA or THA. Hypothyroid patients had significantly higher risks of periprosthetic joint infection (PJI) (odds ratio (OR): 1.69; 95% confidence interval (CI): 1.07 to 2.66, P = 0.01), periprosthetic fracture (OR: 1.26; 95% CI: 1.07 to 1.48, P < 0.01), blood transfusion (OR: 1.68; 95% CI: 1.20 to 2.35, P < 0.01), acute renal failure (OR: 1.23; 95% CI: 1.09 to 1.38, P < 0.01), non-home discharge (OR: 1.47; 95% CI: 1.05 to 2.06, P = 0.025), and anemia (OR: 1.25; 95% CI: 1.13 to 1.37, P < 0.01). In TKA subgroup, hypothyroidism was associated with higher odds of mortality (OR: 1.63; 95% CI: 1.15 to 2.32, P = 0.006), PJI (OR: 1.53; 95% CI: 1.29 to 1.81, P < 0.001), blood transfusion (OR: 1.45; 95% CI: 1.38 to 1.52, P < 0.001), anemia (OR: 1.29; 95% CI: 1.20 to 1.39, P < 0.001), deep vein thrombosis (OR: 1.18; 95% CI: 1.02 to 1.37, P = 0.024), pulmonary embolism OR: 1.50; 95% CI: 1.07 to 2.10, P = 0.018), cardiac complications (OR: 1.21; 95% CI: 1.04 to 1.42, P = 0.014), intubation (OR: 1.44; 95% CI: 1.06 to 1.96, P = 0.018), and renal complications (OR: 1.32; 95% CI: 1.16 to 1.49, P < 0.001). Readmission rate was higher in THA subgroup (OR: 1.40; 95% CI: 1.09 to 1.79, P = 0.009). Other outcomes, including wound complications, dislocation, mechanical loosening, length of hospital stay, and cost, were comparable between patients who did and did not have hypothyroidism. Hypothyroidism is associated with increased risks of some medical and surgical complications following TJA. These findings underscore the need for future research to determine whether thyroid status optimization could influence postoperative risk.