Total Hip Arthroplasty in Patients Who Have Marfan Syndrome: Adverse Events and 5-Year Revision Rates

Wesley Day; Rahul H Jayaram; Lee E Rubin; Jonathan N Grauer

doi:10.1016/j.arth.2023.10.052

Total Hip Arthroplasty in Patients Who Have Marfan Syndrome: Adverse Events and 5-Year Revision Rates

J Arthroplasty. 2023 Nov 10:S0883-5403(23)01098-7. doi: 10.1016/j.arth.2023.10.052. Online ahead of print.

Authors

Wesley Day¹, Rahul H Jayaram², Lee E Rubin², Jonathan N Grauer²

Affiliations

¹ Albert Einstein College of Medicine, Bronx, New York.
² Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut.

PMID: 37952742
DOI: 10.1016/j.arth.2023.10.052

Abstract

Background: Marfan syndrome is a rare inherited connective tissue disease, which may be present in patients who have advanced hip pathologies that may require total hip arthroplasty (THA). The postoperative course of patients who have Marfan syndrome following THA has not yet been defined.

Methods: Adult patients who have and do not have Marfan syndrome and underwent THA were identified in a national database. Patients diagnosed who had infection, trauma, or neoplasms within the 90 days prior to surgery were excluded. Those who have versus those who did not have Marfan syndrome were matched 1:10 based on age, sex, and a comorbidity index. After matching, 144 patients who have Marfan syndrome and 1,440 who do not have Marfan syndrome were identified. The 90-day postoperative adverse events and 5-year revisions were assessed and compared with multivariable analyses and log rank tests, respectively.

Results: Multivariable analyses demonstrated that Marfan syndrome was independently associated with greater odds of 90-day adverse events: venous thromboembolic events (odds ratio [OR]: 2.9, P = .001), cardiac events (OR: 4.5, P = .034), pneumonia (OR: 3.5, P < .001), and urinary tract infections (OR: 5.2, P < .001). There was no significant difference in 5-year rates of revision.

Conclusions: Following THA, Marfan syndrome was independently associated with greater rates of several 90-day adverse events, but not higher 5-year rates of revision. The identified at-risk adverse events may help guide surgeons to improve perioperative care pathways, while having confidence regarding joint survival of THA in this rare disease population.

Keywords: adult reconstruction; connective tissue disease; hip arthroplasty; marfan syndrome; postoperative outcomes; rare disorder.