Patients with History of Metastasis Have Differing Surgical Indications and Increased Perioperative Risk Following Revision Total Joint Arthroplasty

TL;DR

Patients with a history of metastatic cancer face higher risks and complications after revision joint surgery compared to others.

Contribution

This study identifies increased perioperative risks in metastatic cancer patients undergoing revision joint surgery and evaluates predictive factors.

Findings

Metastatic cancer patients undergoing rTKA had significantly higher odds of complications and mortality.

Frailty was a strong predictor of extended hospital stays and mortality in these patients.

Revision arthroplasty for metastatic cancer patients is associated with elevated surgical risks compared to non-metastatic patients.

Abstract

Revision arthroplasty is an invasive procedure with increased morbidity relative to primary joint arthroplasty. Therefore, patients with metastatic cancer (Met) undergoing revision total joint arthroplasty (rTJA) may be at greater risk. This study assesses early postoperative outcomes among Met patients undergoing rTJA.

We reviewed the National Surgical Quality Improvement Program (NSQIP) database from 2015 to 2020 to evaluate rTHA/rTKA with Met and Non-Met. Univariate analysis and multivariate logistic regression were used to evaluate associations of Met patients compared with outcomes using odds ratio (OR) and 95% confidence interval (CI). Discriminatory accuracy was assessed using Receiver operating characteristic (ROC) curve and quantified using C-statistic.

Adjusted analysis revealed Met patients undergoing rTKA were more likely to experience any complication (OR: 2.56, CI: [1.48–4.43]), major complication (OR: 2.17, CI: [1.24–3.82]), and mortality (OR: 7.99, CI: [2.70–23.65]). Met patients undergoing rTHA had higher associations with any complication (OR: 2.40, CI: [1.65–3.49]), major complication (OR: 2.19, CI: [1.47–3.25]), DVT (OR: 4.82, CI: [1.92–12.10]), and mortality (OR: 3.67, CI: [1.43–9.41]). Frailty had superior predictability of extended length of stay (C: 0.625 [0.619–0.630]) and mortality (C: 0.851 [0.824–0.880]).

Patients with metastatic cancer have elevated risk of complications after revision arthroplasty but may have moderate predictability by frailty assessment. Surgeons can utilize this information to emphasize protective strategies to mitigate risk during and following total joint arthroplasty.

III.

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