Background: There have been sporadic reports
on perioperative mortality associated with total knee arthroplasty.
The purpose of this study was to determine risk factors for such
Methods: A computer-assisted review of the records
of 22,540 consecutive patients who had undergone total knee arthroplasty between
1969 and 1997 was performed to identify all patients who had died
within thirty days after the procedure. A detailed analysis of the
medical, surgical, anesthetic, and pathological records of the patients
was performed, and the mortality was determined according to age,
gender, diagnosis, and fixation method.
Results: The rate of mortality within thirty days
after the operation was 0.21% (forty-seven of
22,540). All deaths occurred in the group of 18,810 patients who
had received a cemented implant, and no deaths occurred among the
3730 patients who had received an uncemented implant (p < 0.0001).
The mortality rate was 0.24% (forty-three of 18,165)
after primary arthroplasty and 0.09% (four of 4375) after
revision arthroplasty (p < 0.0003). Three patients (0.01%)
died during the operation. Forty-three of the forty-seven
patients who died had a history of preexisting cardiovascular and/or
pulmonary disease. Simultaneous bilateral total knee arthroplasty
was associated with a significantly higher rate of perioperative mortality
(p < 0.002).
Conclusions: Factors that were associated with a
significantly increased mortality after total knee arthroplasty
included an age of more than seventy years, primary (as compared
with revision) knee surgery, use of a cemented prosthesis, preexisting
cardiopulmonary disease, and simultaneous bilateral arthroplasty.