Key result
Metabolic syndrome linked to ~55% higher complication risk after hip or knee arthroplasty.
Why the study?
It is unclear whether metabolic syndrome is associated with complications after total hip or knee arthroplasty.
Does metabolic syndrome increase the risk of postoperative complications in patients undergoing total hip or knee arthroplasty?
Meta-Analysis (n=1,352,685)
Does metabolic syndrome increase the risk of postoperative complications in patients undergoing total hip or knee arthroplasty?
Relative Risk: 1.55 (95% CI 1.28–1.89)
Metabolic syndrome is associated with a significantly increased risk of postoperative complications, including cardiovascular events and infections, following total hip or knee arthroplasty.
Aims Patients with metabolic syndrome (MetS) are known to be at increased risk of postoperative complications, but it is unclear whether MetS is also associated with complications after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Here, we perform a systematic review and meta-analysis linking MetS to postoperative complications in THA and TKA. Methods The PubMed, OVID, and ScienceDirect databases were comprehensively searched and studies were selected and analyzed according to the guidelines of the Meta-analysis of Observational Studies in Epidemiology (MOOSE). We assessed the methodological quality of each study using the Newcastle-Ottawa Scale (NOS), and we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were extracted and meta-analyzed or qualitatively synthesized for several outcomes. Results Ten cohort studies involving 1,352,685 patients were included. Qualitative analysis suggested that MetS was associated with a higher incidence of cardiovascular events, and meta-analysis showed that MetS increased the risk of all-cause complications (risk ratio (RR) 1.55, 95% confidence interval (CI) 1.28 to 1.89), surgical site infection (SSI; RR 2.99, 95% CI 1.30 to 6.90), urinary tract infection (UTI; RR 2.58, 95% CI 1.03 to 6.43), and 30-day readmission (RR 1.45, 95% CI 1.33 to 1.59). There was insufficient evidence for assessing an association between MetS and venous thromboembolism events, pulmonary or gastrointestinal complications, or mortality. Conclusion Patients with MetS undergoing THA and TKA are at increased risk of all-cause complications, cardiovascular complications, SSI, UTI, and 30-day readmission. Surgeons should be aware of the increased risk of these complications in MetS, and presurgical protocols for these complications should give special consideration to MetS patients. Cite this article: Bone Joint Res. 2020;9(3):120–129.
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Cui et al. (2020) conducted a meta-analysis in Total hip arthroplasty (THA) or total knee arthroplasty (TKA) (n=1,352,685). Metabolic syndrome vs. Patients without metabolic syndrome was evaluated on All-cause complications (RR 1.55, 95% CI 1.28 to 1.89). Metabolic syndrome in patients undergoing total hip or knee arthroplasty increased the risk of all-cause complications (RR 1.55; 95% CI 1.28 to 1.89).
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