JOA - 2026-05-21 - Journal Article
Does Obstructive Sleep Apnea Affect Complications or Patient-Reported Outcomes Following Primary Total Knee Arthroplasty? A Propensity-Matched Analysis.
Kang H, Ilyas MH, Freeman I, Sampson WT, Mannina C, Kwon YM
Topics
Key Takeaway
OSA patients undergoing primary TKA had no significant difference in 90-day medical or 1-2 year surgical complications versus matched controls, and achieved similar MCID rates across all PROMIS and KOOS-PS domains despite lower absolute postoperative scores.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study asked whether OSA independently worsens complications or PROMs after primary TKA using propensity-matched analysis controlling for age, sex, BMI, and comorbidities. No significant differences in 90-day medical complications or 1- and 2-year surgical complications were found between OSA and non-OSA cohorts. OSA patients had lower absolute postoperative PROMIS Physical Function, PROMIS Global Health, and KOOS-PS scores, but delta scores and MCID achievement rates were equivalent, including in the CPAP-documented subgroup.
Key Limitation
OSA severity (AHI grading) and CPAP adherence were not objectively quantified, preventing any dose-response analysis between OSA severity and outcomes.
Original Abstract
BACKGROUND
Obstructive sleep apnea (OSA) affects more than 10% of adults. Prior studies have reported conflicting findings regarding the impact of OSA on postoperative outcomes following primary total knee arthroplasty (TKA), and few have examined patient-reported outcome measures (PROMs). This study aimed to compare PROMs and postoperative complications after primary TKA in patients who had and did not have OSA using a propensity-matched analysis.
METHODS
An institutional database identified 11,210 consecutive primary TKA cases; 5,189 patients had a minimum two-year follow-up with both pre- and postoperative PROMs. Propensity matching was performed at a 1:1 ratio based on age, sex, body mass index, and comorbidities. After matching, 1,119 patients who had OSA and 1,119 patients who did not have OSA were included. Medical complications at 90 days and surgical complications at one and two years were recorded. The absolute scores, delta scores, and minimal clinically important difference (MCID) were evaluated for the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a, PROMIS Global Health Physical, PROMIS Global Health Mental, and the Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form.
RESULTS
There were no significant differences in 90-day medical complications or one- and two-year surgical complications between cohorts (all P > 0.05). Patients who had OSA reported modestly lower absolute postoperative PROMs, whereas delta scores and MCID response distributions were similar. Patients who had documented continuous positive airway pressure use also reported similar improvements in all PROM domains.
CONCLUSION
Preoperative OSA was not associated with increased complications after primary TKA. Despite lower absolute PROMs, patients who had OSA demonstrated similar improvement and MCID achievement rates, indicating preserved patient-perceived benefit after TKA.