Ensuring safety and optimization in total joint arthroplasty of cancer patients: A comprehensive analysis of complication risks and modifiable risk factors

Tara Korbal; Robert Branstetter Iv; Matthew Cable; Deryk Jones; Lizheng Shi; Lauren Hall; Andrew Chapple

doi:10.1016/j.jor.2024.11.027

Ensuring safety and optimization in total joint arthroplasty of cancer patients: A comprehensive analysis of complication risks and modifiable risk factors

J Orthop. 2024 Nov 29:65:8-14. doi: 10.1016/j.jor.2024.11.027. eCollection 2025 Jul.

Authors

Tara Korbal¹, Robert Branstetter Iv¹, Matthew Cable², Deryk Jones³, Lizheng Shi⁴, Lauren Hall⁵, Andrew Chapple⁶

Affiliations

¹ LSUHSC School of Medicine, New Orleans, LA, USA.
² LSUHSC Department of Orthopaedic Surgery, New Orleans, LA, USA.
³ Ochsner Sports Medicine Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.
⁴ Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 6823 Saint Charles Ave, New Orleans, LA, 70118, USA.
⁵ Research, Analytics, and Development Core, Baylor Scott & White Research Institute, Dallas, TX, USA.
⁶ Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA.

PMID: 39713558
PMCID: PMC11656089 (available on 2026-07-01)
DOI: 10.1016/j.jor.2024.11.027

Abstract

Aims & objectives: The primary objective of this study is to determine whether an active cancer diagnosis results in an increased risk of perioperative TJA complications and postoperative mortality. The secondary objective is to analyze the effects of demographic factors on perioperative complication rates in cancer patients undergoing TJA.

Materials & methods: Patients with active cancer diagnoses undergoing total joint arthroplasty from 2014 to 2020 were included in this retrospective analysis. Patient data was obtained through ReachNet, which consisted of data from the University Medical Center, Tulane University Medical Center, Ochsner Health System, and Baylor Scott & White Health. ICD-9/10 codes were tagged for active cancer diagnoses within 365 days before surgery or 30 days after surgery to establish our active cancer population. Acute surgical complications within 30 days were identified by ICD codes.

Results: Patient demographics included predominantly male (51.5 %), white (83 %), and non-Hispanic (96.5 %) patients followed by black individuals (15.9 %) with 47.5 % of patients being smokers. Cancer patients did have a higher acute complication rate (2.6 % vs 1.7 %), but this difference was not significant (p = .139). This difference was higher but also not significant after adjustment (aOR = 1.32, 95 % CI = 0.71-2.43, p = .377). After adjustment, increased Charlson Comorbidity Index (CCI), white race and non-elective surgery were significant contributors to complication risk. Complication rates decreased significantly with year. Nonelective surgeries were also associated with higher complication rates (8.2 % vs. 1.8 %, p = .014).

Conclusion: Patients with active cancer diagnoses demonstrated higher unadjusted rates of TJA acute surgical complications and increased adjusted CCI when compared to non-cancer patients. Identifying risk factors and demographics correlated with increased perioperative complications may provide physicians with necessary information to avoid negative TJA outcomes in cancer patients.