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. 2025 Jun 2;20(6):e0324527.
doi: 10.1371/journal.pone.0324527. eCollection 2025.

Risk factors for perioperative nerve injury associated with total knee arthroplasty: Analysis of a national administrative database

Rahul H Jayaram  1 , Lucas Kim  1 , Wesley Day  1 , Rushabh H Doshi  1 , Lee E Rubin  1 , Jonathan N Grauer  1
Affiliations

Risk factors for perioperative nerve injury associated with total knee arthroplasty: Analysis of a national administrative database

Rahul H Jayaram et al. PLoS One. .

Abstract

Introduction: Nerve injury related to total knee arthroplasty (TKA) is a rare but serious complication. Previous studies identifying risk factors for nerve injury related to TKA have been constrained by institutional data or small cohorts. The current study utilized a comprehensive, national, administrative database to investigate independent risk factors for nerve injury associated with TKA.

Materials and methods: The PearlDiver M161 database was queried for adult TKA procedures performed between 2010 and 2022. Cases with postoperative nerve injury within 90 days of surgery were identified. Factors such as patient age, sex, body mass index (BMI), Elixhauser Comorbidity Index (ECI), fracture indication, and type of surgery (primary vs. revision) were evaluated for their correlation with nerve injury using multivariate analyses.

Results: Out of 1,517,637 TKA procedures, nerve injury was identified for 4,480 (0.3%). Multivariate analysis identified the following independent risk factors for nerve injury, listed in decreasing order of odds ratio (OR): revision surgery (OR: 1.68), female sex (OR: 1.31), ECI ≥ 5 (OR: 1.27), and younger age (OR: 1.02 per decreasing decade) (P < 0.05 for each). Factors not significantly associated with nerve injury included underweight BMI (<20 kg/m2) and fracture indication. A decreased risk of nerve injury was observed in individuals with a BMI ≥ 35 kg/m2 (OR: 0.80, P = 0.002).

Discussion: As expected, the incidence of nerve injury following TKA was low at 0.3%. Independent risk factors were identified for this adverse outcome, with the highest risk associated with revision surgeries. These findings, drawn from the largest cohort studied to date, offer valuable insights for risk stratification, and should inform patient discussions.

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Conflict of interest statement

Financial Disclosures and Conflicts of Interest: Rahul Jayaram: None Lucas Kim: None Wesley Day: Medical/Orthopaedic publications editorial/governing board – Associate editor at the North American Spine Society Journal Rushabh Doshi: None Lee Rubin: Paid consultant - DePuy Synthes, Innovative Medical Products, Thompson Surgical Instruments; Royalties, financial or material support - SLACK, Inc., Johns Hopkins University Press, Inc., Wolters Kluwer; Medical/Orthopaedic publications editorial/governing board - Journal of Arthroplasty, Arthroplasty Today. Jonathan Grauer: Medical/Orthopaedic publications editorial/governing board – North America Spine Society Journal, Editor-in-Chief; Board member/committee appointments - North American Spine Society, Board

Figures

Fig 1
Fig 1. Forest Plot of Multivariate Odds Ratios for Risk Factors Associated with Nerve Injury 90 Days After Total Knee Arthroplasty.
See this image and copyright information in PMC

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