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Background: There have been sporadic reports on perioperative mortality associated with total knee arthroplasty. The purpose of this study was to determine risk factors for such mortality.
Methods: A computer-assisted review of the records of 22,540 consecutive patients who had undergone total knee arthroplasty between 1969 and 1997 was performed to identify all patients who had died within thirty days after the procedure. A detailed analysis of the medical, surgical, anesthetic, and pathological records of the patients was performed, and the mortality was determined according to age, gender, diagnosis, and fixation method.
Results: The rate of mortality within thirty days after the operation was 0.21% (forty-seven of 22,540). All deaths occurred in the group of 18,810 patients who had received a cemented implant, and no deaths occurred among the 3730 patients who had received an uncemented implant (p < 0.0001). The mortality rate was 0.24% (forty-three of 18,165) after primary arthroplasty and 0.09% (four of 4375) after revision arthroplasty (p < 0.0003). Three patients (0.01%) died during the operation. Forty-three of the forty-seven patients who died had a history of preexisting cardiovascular and/or pulmonary disease. Simultaneous bilateral total knee arthroplasty was associated with a significantly higher rate of perioperative mortality (p < 0.002).
Conclusions: Factors that were associated with a significantly increased mortality after total knee arthroplasty included an age of more than seventy years, primary (as compared with revision) knee surgery, use of a cemented prosthesis, preexisting cardiopulmonary disease, and simultaneous bilateral arthroplasty.
Total knee arthroplasty is a common orthopaedic procedure that is performed to treat arthritis that is unresponsive to nonoperative management. This procedure is considered generally safe, with a very low rate of perioperative death. However, because so many total knee arthroplasties are performed in the United States annually, a number of patients are likely to die after this procedure each year. Several authors have reported perioperative mortality rates associated with knee arthroplasty1-12, and several case reports have been published4,6,10,12. The exact cause of many of these deaths and the risk factors associated with mortality after total knee arthroplasty remain unclear. The purpose of this study was to report the rate of mortality within thirty days after total knee replacement in a large consecutive cohort of patients from a single institution....