Patients with sickle cell disease who undergo total knee arthroplasty (TKA) are at higher risk for complications than patients without the disease, according to a large-scale, retrospective study by researchers from UT Southwestern Medical Center and the University of Calgary.
The study, published in Archives of Orthopaedic and Trauma Surgery, also found that patients with sickle cell disease tend to have extended hospital stays and face higher associated health care costs.
“[P]atients [with sickle cell disease] undergoing total knee replacement need a multidisciplinary approach and may be better served in specialized centers capable of caring for these complex medical patients,” said Senthil Sambandam, MD, Assistant Professor of Orthopaedic Surgery at UT Southwestern and lead author of the paper.
“These patients have a higher risk of postoperative complications requiring the involvement of various specialists, including nephrologists, pulmonologists, and hematologists.”
Dr. Sambandam added that the findings of this study also highlight the importance of preventive strategies for patients with sickle cell disease, including patient education and special joint health programs.
Sickle cell disease is the most common congenital blood disorder in the US, affecting about 100,000 people. Diverse skeletal and arthritic issues are common among these patients, and many require joint reconstruction. As the life expectancy of patients with sickle cell disease has increased over the years, so has the proportion of patients needing reconstruction. Yet, there are limited data on patients with sickle cell disease undergoing joint replacement.
To determine the risks associated with joint replacement in patients with sickle cell disease, the researchers used the National Inpatient Sample database to identify patients who had undergone TKA between 2016 and 2019. Patients were divided into two groups: those with sickle cell disease and those without the disease.
A total of 558,361 patients in the database had undergone TKA, of whom 493 (0.08%) were known to have sickle cell disease. A greater proportion of patients with with sickle cell disease were younger, male, and Black compared with patients without the disease, which aligns with previous reports.
Results from the analysis of records found that patients with sickle cell disease were at a significantly higher risk of:
- Developing acute renal failure
- Needing a blood transfusion
- Having deep vein thrombosis
In addition, between 20% and 25% of patients with sickle cell disease experienced acute chest syndrome, pain crisis, or splenic sequestration crisis around the time of surgery, which may have contributed to the longer hospital stays and greater health care costs, the study authors found.
Viswanathan VK, Ramanan SP, Beale J, Subramanian S, Mounasamy V, Sambandam S. How does sickle cell disease affect the peri-operative outcome in patients undergoing total knee arthroplasty? A large-scale, National Inpatient Sample-based study. Arch Orthop Trauma Surg. 2023 Jan 2. doi: 10.1007/s00402-022-04762-1. Online ahead of print.