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. 2025 Aug 4;35(1):339.
doi: 10.1007/s00590-025-04418-x.

Prevalence and impact of preoperative osteoporosis on healthcare utilization and patient-reported outcomes in primary total knee arthroplasty

Alvaro Ibaseta  1 , Ahmed K Emara  1 , Benjamin E Jevnikar  1   2 , Shujaa T Khan  1 , Ignacio Pasqualini  1 , Oguz Turan  3 , Cleveland Clinic Adult Reconstruction Research  1 , Nicolas S Piuzzi  4
Affiliations

Prevalence and impact of preoperative osteoporosis on healthcare utilization and patient-reported outcomes in primary total knee arthroplasty

Alvaro Ibaseta et al. Eur J Orthop Surg Traumatol. .

Abstract

Purpose: Osteoporosis is a well-recognized risk factor for complications after total knee arthroplasty (TKA). However, the effect of pre-TKA osteoporosis on healthcare utilization and patient-reported outcomes is poorly understood. Here, we characterize the association between pre-TKA osteoporosis and (1) healthcare utilization and patient-reported pain and function outcome measures; and (2) dual X-ray absorptiometry (DEXA) scan T-scores and the aforementioned outcomes.

Methods: A prospective cohort of primary elective TKA patients between July 2015 and January 2020 was obtained (n = 6318), of which 4922 (77.9%) completed 1-year follow-up. Outcomes included healthcare utilization (prolonged length of stay (LOS) ≥ 3D, discharge disposition (DD), 90-day readmission, and 1-year reoperation) as well as Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain, KOOS-function (PS) and satisfaction.

Results: The prevalence of pre-TKA osteoporosis was 66.8%, of which 28.7% had a DEXA scan and 66.3% were on osteoporosis medications. Medicated osteoporotic patients were independently associated with higher odds of prolonged LOS (Odds Ratio (OR): 1.21 (95% Confidence Interval (CI) 1.02-1.43)) and non-home DD (OR:1.56 (95%CI 1.25-1.95)). Medicated and non-medicated osteoporosis patients were associated with higher odds of 90-day readmission. The odds of failing to achieve MCID or satisfaction were not associated with preoperative OP diagnosis.

Conclusion: Two-thirds of primary TKA recipients had osteoporosis. Among these patients, two-thirds were on medication and one-third had a DEXA scan. Osteoporotic patients are at a higher risk of 90-day hospital readmission, longer hospital stays and non-home discharge. Interestingly, osteoporosis status was not associated with failure to achieve clinically significant improvements or satisfaction at 1 year following TKA.

Keywords: Discharge disposition; Hospital readmission; Length of stay; Osteoporosis; PROMs; Primary total knee arthroplasty.

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Conflict of interest statement

Declarations. Competing interest: Dr. Alvaro Ibaseta, Dr. Ahmed Emara, Mr. Benjamin Jevnikar, Dr. Shujaa Khan, Dr. Ignacio Pasqualini, Mr. Oguz Turan, Mrs. Yuxuan Jin, Mr. Chao Zhang, and Dr. Peter Surace have no conflicts of interest to disclose. Nicolas Santiago Piuzzi, MD American Association of Hip and Knee Surgeons: Board or committee member ISCT: Board or committee member Journal of Hip Surgery: Editorial or governing board Journal of Knee Surgery: Editorial or governing board Orthopaedic Research Society: Board or committee member Osteal Therapeutics: Research support Pacira: Paid consultant Peptilogics: Research support RegenLab: Research support Signature Orthopaedics: Research support Stryker: Paid consultant Zimmer: Research support Trevor G Murray, MD, FAAOS Biomet: Paid consultant Prichard Medical: Paid consultant Stryker: Research support Zimmer: Paid consultant Robert M Molloy, MD American Association of Hip and Knee Surgeons: Board or committee member Stryker: Paid consultant; Paid presenter or speaker; Research support Zimmer: Research support Kim L Stearns, MD, FAAOS Molnlycke: Paid consultant Viktor Erik Krebs, MD, FAAOS Journal of Arthroplasty: Editorial or governing board Stryker: IP royalties; Paid presenter or speaker Stryker Orthopaedics: Paid consultant Michael R Bloomfield, MD, FAAOS AAOS: Board or committee member American Association of Hip and Knee Surgeons: Board or committee member Stryker: Paid consultant John McLaughlin, DO, FAAOS Smith & Nephew: Paid consultant Zimmer: Paid consultant Matthew Edward Deren, MD, FAAOS Brasseler: Paid presenter or speaker RomTech: Stock or stock Options Wael K Barsoum, MD, FAAOS Beyond Limits: Stock or stock Options Capsico Health: Stock or stock Options Cleveland Clinic: Employee Custom Orthopaedic Solutions: Stock or stock Options Florida Board of Medicine: Board or committee member Health XL: Stock or stock Options Healthcare Outcomes Performance Company (HOPCo): Employee PeerWell: Stock or stock Options PT Genie: Stock or stock Options Sight Medical: Stock or stock Options Stryker: IP royalties.

Figures

Fig. 1
Fig. 1
STROBE diagram depicting inclusion criteria of the present patient cohort
Fig. 2
Fig. 2
Forest plot depicting healthcare outcomes by osteoporosis medication status. OP: Osteoporosis. DD: Discharge disposition. LOS: Length of stay
Fig. 3
Fig. 3
Forest plot depicting 1-year PROMs by osteoporosis medication status. OP: Osteoporosis. MCID: Minimal Clinically Important Difference. KOOS: Knee Disability and Osteoarthritis Outcome Score. PS: Function
Fig. 4
Fig. 4
Forest plot depicting healthcare outcomes by lowest T-Score. DD: Discharge disposition. LOS: Length of stay
Fig. 5
Fig. 5
Forest plot depicting 1-year PROMs by lowest T-score. MCID: Minimal Clinically Important Difference. KOOS: Knee Disability and Osteoarthritis Outcome Score. PS: Function
See this image and copyright information in PMC

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