Poster Explores If Metabolic Syndrome Is Associated with Risk of Patellofemoral Arthroplasty Complications

For patients undergoing patellofemoral arthroplasty (PFA), metabolic syndrome is an independent risk factor for postoperative complications, according to a poster study presented at the AAOS 2024 Annual Meeting. Theodore Quan, MD, orthopaedic surgery resident at George Washington University, presented the findings.

In the United States, about one-third of adults have metabolic syndrome, which comprises several interrelated cardiovascular risk factors such as insulin resistance, obesity, and hypertension. The prevalence has risen over the past several decades and is expected to continue to rise. “Although the impact of metabolic syndrome has been studied in elective procedures, such as lumbar fusions and total joint arthroplasties, its effect on PFA has yet to be elucidated,” the authors noted in their study. This is due to the fact that isolated patellofemoral arthritis, a primary indication for PFA, is relatively uncommon. The researchers sought to confirm the impact of metabolic syndrome on patients undergoing this procedure.

They utilized the National Surgical Quality Improvement Program database to analyze data from patients who underwent PFA between 2007 and 2019. Patients were stratified according to the presence of metabolic syndrome, which was defined as the simultaneous presence of diabetes mellitus, hypertension, and BMI >30 kg/m2. Demographics and comorbidities were compared between both cohorts, as well as incidence of postoperative complications. Analyzed complications included mortality; wound complications; cardiac, pulmonary, renal, thromboembolic, and sepsis complications; urinary tract infections (UTIs); transfusion; extended length of stay (>3 days); reoperation; and readmission.

In total, the study identified 1,618 patients who received PFA. Metabolic syndrome was present in 10.8 percent (n = 175). Patients with metabolic syndrome tended to be older (P = 0.001) and Black (P = 0.002) and were more likely to have an American Society of Anesthesiologists classification of III (P <0.001). chronic obstructive pulmonary disease and dyspnea on moderate exertion were more common in patients with metabolic syndrome (>P = 0.023 and 0.048, respectively). The presence of metabolic syndrome was associated with surgical factors as well, as patients with metabolic syndrome were more likely to require neuraxial anesthesia (P <0.001).></0.001).></0.001).>

Multivariate analysis was utilized to assess the relationship between metabolic syndrome and postoperative outcomes. Metabolic syndrome was associated with a greater odds of UTI (P = 0.028), postoperative transfusion (P = 0.008), and extended length of stay (P = 0.007) (Table 1).

“Despite PFA being a relatively uncommon procedure, determining patient risk factors and creating optimal preoperative and perioperative management plans in patients with metabolic syndrome undergoing PFA can be beneficial in minimizing postoperative complications,” the authors wrote. “This can ultimately improve patient outcomes and reduce overall cost by mitigating the financial burden associated with complications and prolonged hospital stay.”

Dr. Quan’s coauthors of “Metabolic Syndrome: Is This Condition an Independent Risk Factor for Complications following Patellofemoral Arthroplasty?” are Philip M. Parel; Alex Gu, MD; Caillin Marquardt, MD; Sean Tabaie, MD, MBA, FAAOS; Gregory Golladay, MD, FAAOS; and Savyasachi C. Thakkar, MD, FAAOS.

Rebecca Araujo is the managing editor of AAOS Now. She can be reached at raraujo@aaos.org.

References

1. Huang PL: A comprehensive definition for metabolic syndrome. Dis Model Mech 2009;2(5-6):231-7.
2. Hirode G, Wong RJ: Trends in the Prevalence of metabolic syndrome in the United States, 2011-2016. JAMA 2020;323(24):2526-8.