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. 2023 Dec;15(6):935-941.
doi: 10.4055/cios22088. Epub 2022 Dec 29.

Total Knee Arthroplasty: Is It Safe? A Single-Center Study of 4,124 Patients in South Korea

Kyunga Ko  1 , Kee Hyun Kim  1 , Sunho Ko  2 , Changwung Jo  2 , Hyuk-Soo Han  1 , Myung Chul Lee  1 , Du Hyun Ro  1
Affiliations

Total Knee Arthroplasty: Is It Safe? A Single-Center Study of 4,124 Patients in South Korea

Kyunga Ko et al. Clin Orthop Surg. 2023 Dec.

Abstract

Background: Although total knee arthroplasty (TKA) is considered an effective treatment for knee osteoarthritis, it carries risks of complications. With a growing number of TKAs performed on older patients, understanding the cause of mortality is crucial to enhance the safety of TKA. This study aimed to identify the major causes of short- and long-term mortality after TKA and report mortality trends for major causes of death.

Methods: A total of 4,124 patients who underwent TKA were analyzed. The average age at surgery was 70.7 years. The average follow-up time was 73.5 months. The causes of death were retrospectively collected through Korean Statistical Information Service and classified into 13 subgroups based on the International Classification of Diseases-10 code. The short- and long-term causes of death were identified within the time-to-death intervals of 30, 60, 90, 180, 180 days, and > 180 days. Standard mortality ratios (SMRs) and cumulative incidence of deaths were computed to examine mortality trends after TKA.

Results: The short-term mortality rate was 0.07% for 30 days, 0.1% for 60 days, 0.2% for 90 days, and 0.2% for 180 days. Malignant neoplasm and cardiovascular disease were the main short-term causes of death. The long-term (> 180 days) mortality rate was 6.2%. Malignant neoplasm (35%), others (11.7%), and respiratory disease (10.1%) were the major long-term causes of death. Men had a higher cumulative risk of death for respiratory, metabolic, and cardiovascular diseases. Age-adjusted mortality was significantly higher in TKA patients aged 70 years (SMR, 4.3; 95% confidence interval [CI], 3.3-5.4) and between 70 and 79 years (SMR 2.9; 95% CI, 2.5-3.5) than that in the general population.

Conclusions: The short-term mortality rate after TKA was low, and most of the causes were unrelated to TKA. The major causes of long-term death were consistent with previous findings. Our findings can be used as counseling data to understand the survival and mortality of TKA patients.

Keywords: Death; Knee osteoarthritis; Mortality; Total knee arthroplasty.

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Conflict of interest statement

CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. The graph shows the frequency of long-term causes of death of total knee arthroplasty (TKA) patients in descending order.
Fig. 2
Fig. 2. Graphs showing the cumulative incidence rates of deaths from respiratory disease (A), metabolic disease (B), and cardiovascular disease (C) for male and female patients up to 15 years after total knee arthroplasty.
See this image and copyright information in PMC

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