Total Knee Arthroplasty and Homelessness: A Database Study

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA

2 University of Texas Southwestern Medical School, Dallas, Texas, USA

10.22038/abjs.2025.83142.3799

Abstract

Objectives: Homelessness affects over 550,000 individuals in the United States each night, with the number and average age of homeless individuals steadily rising. This population suffers from a higher prevalence of chronic diseases, increasing their vulnerability to adverse health outcomes. Total knee arthroplasty (TKA) is a frequently performed surgery in the United States and is typically successful; however, concerns about postoperative complications are heightened for homeless patients. This study aimed to compare complication rates between homeless and non-homeless patients undergoing TKA.
Methods: A retrospective cohort study was conducted using the TriNetX Research Network database. Patients who underwent primary TKA were identified using CPT codes 27447, with homeless patients classified using ICD-9 and ICD-10 codes. A total of 245,567 patients were included, with 463 categorized as homeless. Demographic variables and postoperative complications were analyzed, and odds ratios (OR) were calculated for various outcomes, comparing homeless to non-homeless patients. Chi-square analysis and Fisher’s exact test were used to determine statistical significance.
Results: Homeless patients were more likely to be over 65, obese, diabetic, and smokers, all of which are risk factors for poor postoperative outcomes. Superficial surgical site infections (0.6 versus 0.1% p=0.008, OR 7.52; 95% CI: 2.40–23.63), prosthetic joint infections (2.2 versus 0.8% p=0.005, OR 2.70; 95% CI: 1.44–5.06), acute renal failure (4.5 versus 1.9% p<0.001, OR 2.44; 95% CI: 1.57–3.78), blood loss anemia (13.2 versus 6.1% p<0.001, OR 2.25; 95% CI: 1.72 –2.95), and pulmonary embolism (2.4 versus 0.9 p<0.003, OR 2.81; 95% CI: 1.54–5.12) occurred more frequently in homeless patients.
Conclusion: Homeless patients undergoing TKA face significantly higher risks of postoperative complications compared to their non-homeless counterparts. These findings underscore the need for targeted preoperative optimization and tailored postoperative care to improve outcomes for this vulnerable population.
        Level of evidence: IV 

Keywords

Main Subjects

References

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The Archives of Bone and Joint Surgery
Volume 13, Issue 8
August 2025
Pages 470-478

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History

  • Receive Date: 21 October 2024
  • Revise Date: 30 July 2025
  • Accept Date: 04 January 2025

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