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J Knee Surg
DOI: 10.1055/a-2824-9079
Original Article

Fibromyalgia as a Risk Factor for Postoperative Complications following Total Knee Arthroplasty

Authors

  • Levi Mozart Travis

    1   Orthopaedic surgery, University of Miami Miller School of Medicine, Miami, United States (Ringgold ID: RIN12235)

  • Hallie Brooke Remer

    1   Orthopaedic surgery, University of Miami Miller School of Medicine, Miami, United States (Ringgold ID: RIN12235)

  • Aneesh Samineni

    1   Orthopaedic surgery, University of Miami Miller School of Medicine, Miami, United States (Ringgold ID: RIN12235)

  • Gilberto Oscar Lobaton

    1   Orthopaedic surgery, University of Miami Miller School of Medicine, Miami, United States (Ringgold ID: RIN12235)

  • Michele Raul D'Apuzzo 

    2   Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, United States (Ringgold ID: RIN12235)
Further Information
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Background: Fibromyalgia is characterized by chronic, diffuse musculoskeletal pain and tenderness, associated with fatigue, sleep issues, brain fog, and depression. The effects of fibromyalgia on total knee arthroplasty (TKA) are yet to be fully understood. Previous analyses looking at patients with fibromyalgia undergoing primary TKA have shown an increased risk of developing postoperative complications; however, all have been conducted without controlling for other risk factors including opioid use. Methods: We conducted a retrospective cohort study using the National Inpatient Sample identified patients with fibromyalgia undergoing unilateral, primary TKA from 2016 to 2021. Patients with fibromyalgia were matched 1:1 to patients without fibromyalgia accounting for age, sex, race, ethnicity, insurance, modified Elixhauser comorbidities, smoking, and opioid use. Results: After matching, there were a total of 96,870 (n=48,435 per group) patients who met inclusion and exclusion criteria for this study. For those undergoing primary TKA, fibromyalgia was associated with higher rates of postoperative hypotension (3.11% vs. 2.68%, OR 1.16, p<0.01), anemia (14.51% vs. 13.60%, OR 1.07, p<0.01), atelectasis (0.71% vs 0.59%, OR 1.21, p<0.01), urinary retention (1.28% vs 1.09%, OR 1.17, p<0.01), fluid and electrolyte imbalance (6.46% vs. 5.82%, OR 1.11, p<0.01), intestinal obstruction (0.44% vs 0.23%, OR 1.95, p<0.01), constipation (3.59% vs. 3.31%, OR 1.08, p=0.01), and delirium (0.58% vs 0.44%, OR 1.30, p<0.01). A higher percentage of patients in the fibromyalgia cohort were not discharged directly home compared to control (18.1% vs. 15.4%, p<0.01). Discussion: This present study showed that patients with fibromyalgia had higher rates of postoperative complications compared to a matched control cohort, even when accounting for opioid use.



Publication History

Received: 23 August 2025

Accepted after revision: 01 March 2026

Accepted Manuscript online:
05 March 2026

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