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A History of Past Prostate Cancer Still Carries Risk After Total Knee Arthroplasty
Prostate cancer (PCa) is one of the most prevalent diseases in the North American elderly population. Moreover, many patients undergo prostate resection without further treatment and are often considered cured. As such, it is expected that many undergo total knee arthroplasty (TKA) for osteoarthritis while having a history of PCa. Nonetheless, limited research is available on this topic, and without it, surgeons may not be aware of increased complication rates. Therefore, the purpose of this study was to evaluate whether patients at a national level with a history of PCa are at increased risk for complications after TKA. A retrospective case–control, comorbidity matched paired analysis was performed. Patients were identified based on International Classification of Diseases, Ninth Revision codes and matched 1:1 ratio to age, smoker status, chronic kidney disease, diabetes, chronic lung disease, smoking status, and obesity. Patients with active disease were excluded. The 90-day outcomes of TKA were compared through univariate regressions (odds ratios [ORs] and 95% confidence intervals). A total of 2,381,706 TKA patients were identified, and after matching, each comprised 113,365 patients with the same prevalence of the matched comorbidities and demographic characteristics. A significant increase in thromboembolic events that was clinically relevant was found in pulmonary embolisms (PEs) (1.44 vs. 0.4%, OR: 3.04, p < 0.001), Moreover, an increased rate of deep vein thromboses was also seen but was found to be not clinically significant (2.55 vs. 2.85%, OR: 1.19). Although length of stay and other complications were similar, average reimbursements were higher for those with a history of PCa. In conclusion, a history of prior PCa carries significant risk as these patients continue to develop increased PE rates during the 90-day postoperative period which appears to lead to greater economic expenditure. Surgeons and payers should include this comorbidity in risk and patient-specific payment models.
Received: 05 April 2019
Accepted: 15 July 2019
Article published online:
28 August 2019
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- 1 Lawrence RC, Felson DT, Helmick CG. et al; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008; 58 (01) 26-35
- 2 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
- 3 Goltz DE, Ryan SP, Hopkins TJ. et al. A novel risk calculator predicts 90-day readmission following total joint arthroplasty. J Bone Joint Surg Am 2019; 101 (06) 547-556
- 4 Alamanda VK, Springer BD. The prevention of infection: 12 modifiable risk factors. Bone Joint J 2019; 101-B (1_supple_A): 3-9
- 5 Workman KK, Angerett N, Lippe R, Shin A, King S. Thirty-day unplanned readmission after total knee arthroplasty at a teaching community hospital: rates, reasons, and risk factors. J Knee Surg 2019; DOI: 10.1055/s-0038-1677510.
- 6 Karam JA, Huang RC, Abraham JA, Parvizi J. Total joint arthroplasty in cancer patients. J Arthroplasty 2015; 30 (05) 758-761
- 7 Sabeh KG, Rosas S, Buller LT. et al. The impact of medical comorbidities on primary total knee arthroplasty reimbursements. J Knee Surg 2018; DOI: 10.1055/s-0038-1651529.
- 8 Rosas S, Luo TD, Jinnah AH. et al. Previous history of breast cancer increases rates of pulmonary embolism and costs after total knee arthroplasty: an evaluation of 185,114 matched patients. J Knee Surg 2018; DOI: 10.1055/s-0038-1641155.
- 9 Rosas S, Marquez-Lara A, Bracey DN, Kurowicki J, Roche MW, Emory CL. History of breast cancer increases 90-day pulmonary embolism rates and reimbursements after total hip arthroplasty: a national matched-pair analysis. J Arthroplasty 2018; 33 (03) 893-896
- 10 Haas GP, Delongchamps N, Brawley OW, Wang CY, de la Roza G. The worldwide epidemiology of prostate cancer: perspectives from autopsy studies. Can J Urol 2008; 15 (01) 3866-3871
- 11 Weiner AB, Matulewicz RS, Eggener SE, Schaeffer EM. Increasing incidence of metastatic prostate cancer in the United States (2004-2013). Prostate Cancer Prostatic Dis 2016; 19 (04) 395-397
- 12 Brawley OW. Trends in prostate cancer in the United States. J Natl Cancer Inst Monogr 2012; 2012 (45) 152-156
- 13 Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; comprehensive care for joint replacement payment model for acute care hospitals furnishing lower extremity joint replacement services. Final rule. Fed Regist 2015; 80 (226) 73273-73554
- 14 Kao FC, Hsu YC, Lai PY, Wang CB, Tu YK, Chen WK. One-year mortality and periprosthetic infection rates after total knee arthroplasty in cancer patients: a population-based cohort study. BMC Cancer 2018; 18 (01) 628
- 15 Grauer JN, Leopold SS. Editorial: large database studies--what they can do, what they cannot do, and which ones we will publish. Clin Orthop Relat Res 2015; 473 (05) 1537-1539