Sarcopenia in total joint Arthroplasty: Risk factor for poor postoperative outcomes and higher costs of care

Abstract

Background: For patients undergoing total joint arthroplasty (TJA), sarcopenia has been described as a modifiable risk factor for several medical complications and adverse functional and patient-reported outcomes. However, findings have varied among orthopaedic literature as some studies encompass patients who do not have a clinical diagnosis of sarcopenia. This systematic review therefore sought to clarify the association between clinically diagnosed sarcopenia and post-TJA (1) functional outcomes, (2) patient-reported outcome measures (PROMs), and (3) complications.

Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, Google Scholar, and EBSCOhost databases were queried for articles evaluating the effect of preoperative sarcopenia or sarcopenic obesity on total hip or total knee arthroplasty (THA; TKA) outcomes. Exclusion criteria included case reports, non-English publications, systematic reviews, and duplicate studies among databases. Eligibility screening of articles and data extraction were performed independently by two reviewers. Risk of bias was assessed using the Methodological index for Nonrandomized Studies tool.

Results: The synthesis of evidence indicates that preoperative sarcopenia does not substantially impact functional outcomes such as gait speed, one-legged stand time, or postoperative knee range of motion after THA or TKA. However, sarcopenic patients tend to report worse PROMs post-TJA than non-sarcopenic patients, particularly in the short term. Complications are more frequent in sarcopenic patients post-TKA, including higher rates of pneumonia, urinary retention, anemia, and deep vein thrombosis. Orthopaedic-related complications, such as prosthetic dislocation and fragility fractures, are also more common after both THA and TKA. Surgical costs are higher for both sarcopenic patients undergoing either THA or TKA, with increased day-of-surgery and 90-day care costs.

Conclusion: Sarcopenic patients are at an increased risk for complications and impaired performance and outcome measures following TJA. Surgeons may consider preoperative optimization and rehabilitation in TJA patients with sarcopenia.

Keywords: Cost of care; Postoperative outcomes; Sarcopenia; Sarcopenic obesity; Total hip arthroplasty; Total joint arthroplasty; Total knee arthroplasty.