Systemic sclerosis is associated with knee arthroplasty outcomes: a National US study

  • Jasvinder A. SinghEmail author
  • John D. Cleveland
Original Article
Part of the following topical collections:
  1. Topical Collection on Updates in Systemic Sclerosis



To assess whether systemic sclerosis (SSc) is associated with total knee arthroplasty (TKA) outcomes.


We used the 1998–2014 US National Inpatient Sample. We conducted multivariable-adjusted logistic regression analyses to examine the association of a diagnosis of SSc with post-TKA in-hospital complications (implant infection, revision, transfusion, mortality) and healthcare utilization (hospital charges, hospital stay, non-home vs. home discharge). Odds ratios (OR) and 95 % confidence intervals (CI) were calculated.


Our cohort included 8,123,388 people without SSc and 3894 people with SSc. In multivariable-adjusted analyses, compared to people without SSc, people with SSc had higher odds of transfusion, hospital stay > 3 days and non-home discharge with higher OR of 1.42 (95 % CI, 1.20, 1.69), 1.29 (95 % CI, 1.11, 1.49), and 1.29 (95 % CI, 1.11, 1.49), respectively. No differences were seen in revision, 0.68 (95 % CI, 0.10, 4.69) or hospital charges above the median, 1.01 (95 % CI, 0.70, 1.46). Differences in implant infection or mortality were not estimable, since none of the patients with SSc had implant infection or died. Sensitivity analyses that adjusted the main analysis additionally for hospital-level variables confirmed study findings with minimal or no attenuation of OR.


SSc was associated with higher risk of transfusion and increased healthcare utilization after TKA. Future studies should examine if interventions can address modifiable factors to further optimize these outcomes.

Key Points

Systemic sclerosis was independently associated with higher healthcare utilization after TKA.

The adjusted odds of transfusion was higher in people with systemic sclerosis compared to those without systemic sclerosis who underwent TKA.


Systemic sclerosis Total knee arthroplasty National Inpatient Sample Healthcare utilization TKA In-hospital complications Outcomes 



JAS is supported by the resources and the use of facilities at the VA Medical Center at Birmingham, Alabama, USA.

Compliance with ethical standards

Conflict of interest

There are no financial conflicts related directly to this study. JAS has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Medscape, WebMD, Clinical Care options, Clearview healthcare partners, Putnam associates, Spherix, the National Institutes of Health and the American College of Rheumatology. JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies. JAS serves on the FDA Arthritis Advisory Committee. JAS is a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. JAS previously served as a member of the following committees: member, the American College of Rheumatology’s (ACR) Annual Meeting Planning Committee (AMPC) and Quality of Care Committees, the Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee and the co-chair of the ACR Criteria and Response Criteria subcommittee. JDC has no conflicts.

IRB approval

The study was approved by the Institutional Review Board (IRB) at the University of Alabama at Birmingham (UAB; X120207004).


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Birmingham Veterans Affairs (VA) Medical CenterBirminghamUSA
  2. 2.Department of Medicine at the School of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Division of Epidemiology at the School of Public HealthUniversity of Alabama at BirminghamBirminghamUSA

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