JOA - 2026-06-01 - Journal Article; Systematic Review; Meta-Analysis
Hypothyroidism Is Associated With Increased Medical and Surgical Complications Following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.
Shaker F, Pahlevan Fallahy MT, Asgari AM, Behrouzieh S, Borazjani R, Kreuzer SW
Topics
Key Takeaway
Hypothyroidism increases PJI risk by 69% (OR 1.69) and periprosthetic fracture risk by 26% (OR 1.26) following TJA across 18 studies and 4,622,479 procedures.
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Summary
This PRISMA-compliant meta-analysis quantified the impact of hypothyroidism on TJA outcomes by pooling 18 studies through October 2024. Hypothyroidism significantly increased odds of PJI (OR 1.69), periprosthetic fracture (OR 1.26), blood transfusion (OR 1.68), acute renal failure (OR 1.23), anemia (OR 1.25), and nonhome discharge (OR 1.47). TKA subgroup analysis additionally demonstrated increased mortality (OR 1.63), DVT (OR 1.18), PE (OR 1.50), and cardiac complications (OR 1.21), while wound complications, dislocation, mechanical loosening, LOS, and cost were not significantly different.
Key Limitation
Inability to stratify outcomes by thyroid function control status (euthyroid on medication vs. subclinical vs. overt hypothyroidism) prevents determination of whether risk is attributable to the disease itself or inadequate medical management.
Original Abstract
BACKGROUND
Total joint arthroplasty (TJA) is an effective treatment for end-stage osteoarthritis. However, hypothyroidism, even when medically controlled, has been linked to higher rates of postoperative complications. This meta-analysis assessed the impact of hypothyroidism on outcomes after total hip or total knee arthroplasty.
METHODS
A comprehensive search was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines across PubMed, Embase, Web of Science, and Scopus through October 2024. Studies comparing outcomes after TJA by thyroid status (18 studies, 4,622,479 TJAs) were included.
RESULTS
Hypothyroidism significantly increases the risks of periprosthetic joint infection (odds ratio (OR): 1.69; 95% confidence interval (CI): 1.07 to 2.66, P = 0.01), periprosthetic fracture (OR: 1.26; 95% CI: 1.07 to 1.48, P < 0.01), blood transfusion (OR: 1.68; 95% CI: 1.20 to 2.35, P < 0.01), acute renal failure (OR: 1.23; 95% CI: 1.09 to 1.38, P < 0.01), nonhome discharge (OR: 1.47; 95% CI: 1.05 to 2.06, P = 0.025), and anemia (OR: 1.25; 95% CI: 1.13 to 1.37, P < 0.01). In total knee arthroplasty subgroup, hypothyroidism increased the odds of mortality (OR: 1.63; 95% CI: 1.15 to 2.32, P = 0.006), periprosthetic joint infection (OR: 1.53; 95% CI: 1.29 to 1.81, P < 0.001), blood transfusion (OR: 1.45; 95% CI: 1.38 to 1.52, P < 0.001), anemia (OR: 1.29; 95% CI: 1.20 to 1.39, P < 0.001), deep venous thrombosis (OR: 1.18; 95% CI: 1.02 to 1.37, P = 0.024), pulmonary emboli (OR: 1.50; 95% CI: 1.07 to 2.10, P = 0.018), cardiac complications (OR: 1.21; 95% CI: 1.04 to 1.42, P = 0.014), intubation (OR: 1.44; 95% CI: 1.06 to 1.96, P = 0.018), and renal complications (OR: 1.32; 95% CI: 1.16 to 1.49, P < 0.001). Readmission rate was higher (OR: 1.40; 95% CI: 1.09 to 1.79, P = 0.009) after total hip arthroplasties. Other outcomes, including wound complications, dislocation, mechanical loosening, hospital stay, and cost, were comparable between groups.
CONCLUSIONS
Hypothyroidism is associated with increased risks of some medical and surgical complications following TJA; therefore, studies should evaluate whether optimizing thyroid function can reduce these risks.