Patients With Multiple Sclerosis are at Increased Risk for Postoperative Complications Following Total Hip and Knee Arthroplasty

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease affecting the central nervous system. Patients with MS are living longer due to improved medical therapy and thus the demand for arthroplasty in this population will increase. The objective of this study is to evaluate MS as a potential risk factor for postoperative complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Patients with a diagnosis of MS who underwent THA or TKA from 2005 to 2014 were identified in a national insurance database. Rates of death, hospital readmission, emergency room visits, infection, revision, and dislocation (for THA) or stiffness (for TKA) were calculated, in addition to cost and length of stay. MS patients were then compared to a matched control population.

In total, 3360 patients who underwent THA and 6436 patients who underwent TKA with a history of MS were identified and compared with 10:1 matched control cohorts without MS. The MS group for both TKA and THA had significantly higher incidences of hospital readmission (THA odds ratio [OR] 2.05, P< .001; TKA OR 1.99, P < .001), emergency room visits (THA OR 1.41, P < .001; TKA OR 1.66, P < .001), and infection (THA OR 1.35, P = .001; TKA OR 1.32, P < .001). MS patients who underwent THA had significantly higher rates of revision (OR 1.35, P = .001) and dislocation (OR 1.52, P < .001). Diagnosis of MS was also associated with significantly higher costs and hospital length of stay for patients undergoing both TKA and THA.

A diagnosis of MS is associated with increased risk of postoperative complications and higher costs following both THA and TKA.