Individuals with systemic sclerosis (SSc) experience an increased risk for medical and surgical postoperative complications following total knee arthroplasty (TKA), according to findings from a study published in the journal International Orthopaedics.

Among patients with SSc, arthritic pain can be associated with radiographic changes. Between 40% and 80% of patients with the disorder experience some type of musculoskeletal pain; however, few studies have evaluated the management of such pain in this population. In addition, rates of osteoporosis and related fractures are elevated among women with SSc compared with those in the general population.

Because musculoskeletal pain is associated with quality of life among individuals with SSc, many patients with the disorder may ultimately benefit from undergoing TKA to improve arthritic-related pain. The researchers of the present analysis sought to examine the rate of postoperative complications among patients with SSc undergoing TKA at 2-year follow-up, in an effort to provide more data on the specific risks faced by this patient population and thus optimize their future perioperative management of these individuals.

The PearlDiver Patient Records Database, which is a national private payer insurance database, was used for the current study. The database was searched for patients with SSc who underwent TKA. A 10:1 matched control cohort of patients without SSc who underwent TKA was created, based on gender, age, and Elixhauser Comorbidity Index.

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A total of 2002 individuals with SSc and 19,892 patients without SSc who underwent TKA were identified. The patients were divided into several different age groups, as follows:

  • less than 40 years of age
  • 40 to 49 years of age
  • 50 to 59 years of age
  • 60 to 69 years of age
  • 70 to 79 years of age
  • more than 79 years of age

The investigators used multivariable logistic regression analyses to evaluate medical complications reported up to
90 days postsurgery and surgical complications reported up to 2 years postsurgery. They recorded 90-day emergency department visits and inpatient readmissions as well.

Study results showed that patients with SSc compared with matched controls exhibited significantly higher rates of medical complications, including cerebrovascular accidents (1.5% vs 0.6%, respectively; P <.001), myocardial infarctions (1.3% vs 0.3%, respectively; P <.001), and sepsis (1.1% vs 0.4%, respectively; P <.001).

Further, individuals with SSc vs matched controls experienced increased rates of surgical complications, including the following:

  • Wound complications: 3.9% vs 2.2%, respectively; P <.001
  • Aseptic loosening at 90 days: 0.2% vs 0.1%, respectively; odds ratio [OR], 3.53; 95% CI, 1.13 to 9.28
  • Aseptic loosening at 1 year: 0.7% vs 0.4%, respectively; OR, 1.78; 95% CI, 0.96 to 3.05
  • Aseptic loosening at 2 years: 1.4% vs 0.9%, respectively; OR, 1.68; 95% CI, 1.10 to 2.45

Also, individuals with SSc also reported significantly higher rates of emergency department visits compared with controls (21.2% vs 11.4%, respectively; P <.001).

“It is crucial for orthopedic surgeons and patients alike to consider the elevated risks when determining a course of TKA for patients with SSc,” the researchers concluded.


Driskill E, Zhang Z, Chi J, Cui Q. Increased rate of complications following total knee arthroplasty in patients with systemic sclerosis. Int Orthop. Published online June 24, 2023. doi:10.1007/s00264-023-05873-z