Are patients with marfans syndrome undergoing total joint arthroplasty at increased risk for revision surgery?

Abstract

Introduction: Marfan Syndrome (MFS) presents unique challenges for total joint arthroplasty (TJA), yet its long-term outcomes are not well-documented. This study aimed to assess whether MFS patients are more likely to require revision compared to those without MFS and to identify specific revision causes with elevated risks. Methods: We performed a retrospective analysis using a national claims database to find patients who had undergone total knee arthroplasty (TKA) or total hip arthroplasty (THA). MFS patients were matched to non-MFS patients in a 1:4 ratio based on age, sex, and Charlson Comorbidity Index (CCI). We used Kaplan-Meier analyses and Cox proportional hazards models to evaluate the cumulative incidence and risks of revision for both groups. Results: MFS patients who had THA were at a higher risk of needing revision due to instability (HR: 4.82; 95 % CI: 1.07–21.62; P = 0.039) compared to non-MFS patients. However, there were no significant differences in revision risk for all causes or for revisions due to periprosthetic joint infection, mechanical loosening, or periprosthetic fracture after THA between MFS and matched control patients. Similarly, no significant differences were found in revision risk after TKA. Discussion: Our matched cohort study indicates that MFS patients have similar risks of all-cause revision after TJA compared to non-MFS patients. Nonetheless, MFS patients face nearly a fivefold increased risk of instability five years after THA. Further research should explore whether this risk can be mitigated through changes in surgical technique.

Keywords

• Marfan syndrome
• Total hip arthroplasty
• Total knee arthroplasty
• Joint laxity
• Revision surgery
• Total hip replacement