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The global obesity epidemic continues to fuel a dramatic surge in non-alcoholic fatty liver disease (NAFLD), now recognized as the key cause of chronic liver disease.
Non-cirrhotic NAFLD patients have lower postoperative complication rates after total knee arthroplasty compared with non-alcoholic cirrhosis patients.
The global obesity epidemic continues to fuel a dramatic surge in non-alcoholic fatty liver disease (NAFLD), now recognized as the key cause of chronic liver disease. Given the strong link between obesity, metabolic syndrome, NAFLD, and knee osteoarthritis, orthopedic surgeons are increasingly tackling these high-risk patients requiring total knee arthroplasty (TKA).
Although cirrhosis is widely acknowledged as a predictor of adverse surgical outcomes, the independent effect of non-cirrhotic NAFLD on postoperative complications after TKA remains poorly defined. This retrospective cohort analysis explored complication rates in NAFLD compared with those with non-alcoholic cirrhosis (NAC) undergoing primary TKA.
This study was performed using the Mariner database, a nationwide administrative claims dataset covering more than 151 million U.S. patients. Researchers identified 1,767,399 individuals who underwent primary TKA. After applying strict inclusion criteria—including continuous enrollment, first-time procedures, and validated liver disease coding—NAFLD sufferers were identified using ICD-9/10 codes.
A 1:1 propensity score matching model was applied for matching NAFLD sufferers with NAC sufferers based on age, gender, Charlson Comorbidity Index, and key medical comorbidities. Postoperative outcomes at 90 days and 1 year were assessed via multivariable logistic regression with adjustment for demographic and clinical variables.
The final matched cohort incorporated 14,866 patients (7,433 NAFLD; 7,433 NAC). Compared with the matched NAC group, the NAFLD group showed substantially lower overall complication burden. It also exhibited reduced rates of periprosthetic joint infection, pulmonary embolism, hematoma formation, acute kidney injury, blood transfusion, and reoperation rates (Table 1).
However, NAFLD sufferers depicted greater rates of manipulation under anesthesia and hospital readmission at both 90 days and 1 year.
Despite a high burden of metabolic comorbidities, NAFLD patients experienced fewer serious postoperative complications following TKA compared with NAC patients. These outcomes suggest that non-cirrhotic NAFLD may carry a lower perioperative risk profile and must not be considered a major contraindication for TKA.
Journal of ISAKOS
Increased risk of postoperative complications in non-alcoholic cirrhosis versus non-alcoholic fatty liver disease following total knee arthroplasty: A national matched cohort study
Jared Sasaki et al.
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