Are Patients Who Have Sarcoidosis at Increased Risk of Adverse Postoperative Outcomes Following Total Knee Arthroplasty?

Abstract

Sarcoidosis is a multisystem inflammatory disease most observed in middle-aged adults, a population increasingly electing for total joint reconstruction. Musculoskeletal manifestations of sarcoidosis, including arthritis, occur in up to 40% of cases, prompting the need for orthopaedic involvement. Our study investigated whether sarcoidosis patients undergoing total knee arthroplasty (TKA) would be at increased risk for adverse postoperative outcomes. Using a national database, patients who underwent primary TKA over the past 20 years were identified, of which 1,829 had a history of sarcoidosis while 355,773 had no such history. The two cohorts were subsequently 1:1 propensity matched based on demographic factors and comorbidities, including diabetes, kidney disease, obesity, and nicotine dependence. Sarcoidosis patients had a significantly increased prevalence of all comorbidities measured. Upon matching, 1,825 patients were included in each cohort. The primary outcomes were the risks of 2-year revision and mechanical complications. The secondary outcomes were risks of 90-day postoperative stroke, thromboembolic events, pneumonia, pulmonary hypertension, acute kidney injury (AKI), and all-cause emergency department (ED) visits. Tests of significance (alpha = 0.05) were performed, and risk ratios (RRs) were calculated. There were no significant differences noted in the risks of orthopaedic complications at two years between cohorts. However, sarcoidosis patients did experience a significantly increased risk for AKI (4.2 versus 2.7%; RR = 1.54; P = 0.01), pulmonary hypertension (2.9 versus 1.4%; RR = 2.12; P = 0.001), and ED visits (16.9 versus 13.5%; RR = 1.247; P = 0.005) within 90 days following TKA. Sarcoidosis patients generally have additional comorbidities that are known risk factors for adverse post-TKA outcomes. A sarcoidosis diagnosis alone increases the risk for 90-day complications and resource utilization, but not 2-year mechanical complications. Awareness of the identified medical complication risks may benefit the counseling and postoperative care of these patients.