Patients with hypothyroidism more prone to complications than euthyroid patients following TKA

The number of hypothyroidism patients undergoing total knee replacement (TKA) in India is increasing. It is assumed that patients with hypothyroidism are more prone to complications following surgery. V. Ratnakar et al conducted a study to evaluate the impact of hypothyroidism on the complications following TKA. The study has been published in “Indian Journal of Orthopaedics”

A case–control analysis of patients who underwent primary total knee replacement was included in the study. Patient is considered hypothyroid when TSH levels are more than 5.60 mIU/mL or patients who were diagnosed hypothyroidism previously and were on treatment with thyroxin. Age, sex, BMI, pre-operative hemoglobin, blood trans fusion required, pre-operative and post-operative serum sodium levels, length of hospital stay, wound complications (like delayed wound healing, superficial surgical site infection, PJI), DVT and Pulmonary embolism within 90 days of index surgery were retrieved from institutional records. For hypothyroid patients, duration of hypothyroidism, dose of thyroid medication and pre-operative TSH levels were retrieved from records.

Key findings of the study were:

• A total of 600 patients were analyzed (Hypothyroid group n = 300, Control group n = 300).

• The mean age was 61.15 years in patients with hypothyroid and 61.34 in the control group.

• In both groups female preponderance was major.

• The medical complications were found to be 6.2% in the hypothyroid group compared to 4% in control group (p = 1.66, odds ratio 0.61).

• Surgical complications in the hypothyroid group were 3% compared to 0.6% in control group (p = 4.53, odds ratio = 0.21), overall complication rates were not significant statistically when compared between hypothyroid and control group (p = 5.01, odds ratio 0.47).

• Subgroup analysis of complications of hypothyroid patients with euthyroid status versus uncontrolled hypothyroidism was done and found no statistical difference in complications.

“The conclusion is that the rate of hospital stay, surgical site infections and complications were higher in hypo thyroid group when compared with control group though statistically not significant” the authors commented.

Further reading:

Effect of Hypothyroidism on Complications in Patients Undergoing TKA in Indian Population

V. Ratnakar, Sawankumar Pawar et al

Indian Journal of Orthopaedics (2023) 57:673–678

https://doi.org/10.1007/s43465-023-00841-6