Patients with Down syndrome at greater risk of complications after hip, knee replacement

People with Down syndrome (DS) are increasingly being considered for procedures like joint replacements. In a new study, a team of researchers at Yale School of Medicine's Department of Orthopaedics and Rehabilitation say total hip and knee arthroplasty carries additional risks for this population.

The average lifespan of people with DS increased from 25 years in 1983 to 49 years in 1997 (Yang et al, 2002). As a result, more people with DS are being considered for total hip arthroplasty (THA) and total knee arthroplasty (TKA). "Currently, there is little to no scientific literature examining outcomes in this patient population," said Scott Halperin, a medical student at Yale School of Medicine and lead author of the study. "We believe it is important to examine the risks associated with this common procedure."

Using data from a large national administrative claims data set, researchers compared patients with DS undergoing both procedures with matched controls. Using multivariable logistic regression, they found patients with DS had no additional risk of surgical revisions compared to controls - but the DS patients experienced significantly greater odds of other complications.

For patients undergoing THA, the team found patients with DS experienced 2.4 times greater odds of any adverse events, including 7.5 times greater odds of sepsis, 5.3 times greater odds of acute kidney injury, and 8.9 times greater odds of pneumonia.

For patients undergoing TKA, patients with DS experienced 2.5 times greater odds of any adverse events, including 7.1 times greater odds of sepsis, 3.4 times greater odds of acute kidney injury, and 8.3 times greater odds of pneumonia.

The team hopes its findings will contribute to safer orthopaedic procedures for patients in this population. "The goal of our study was to shed light on these adverse events both for physicians and for future research directions," Halperin said.