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Background <p>Use of cementless total knee arthroplasty (TKA) has increased in recent years, but contemporary short-term administrative comparisons with cemented fixation remain limited. This study compared 90-day readmission and early postoperative complications after ICD-10-PCS coding-defined cementless-category versus cemented-category primary TKA using a large U.S. administrative readmission database.</p> Methods <p>The 2020–2022 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD) was queried for adults undergoing elective unilateral primary TKA for osteoarthritis. Only cases performed on hospital day 0 using common cemented and cementless ICD-10-PCS procedure codes were included. Fixation category was defined using ICD-10-PCS administrative procedure coding and was analyzed as coding-defined cementless-category versus cemented-category primary TKA. Non-elective admissions, bilateral procedures, revision or reoperation cases, fracture-, malignancy-, infection-, and COVID-19-related admissions, and index discharges after September were excluded. Readmissions involving contralateral knee arthroplasty were also excluded. Propensity-score matching was performed on the unweighted analytic sample, and DISCWT was applied after matching to generate weighted national estimates and proportions. The primary outcome was 90-day all-cause readmission. Secondary outcomes included intraoperative fracture, blood loss anemia, blood transfusion, stratified in-hospital complications, readmission burden, grouped primary causes of readmission, and grouped principal procedures performed during readmission.</p> Results <p>The 1:1 matched analytic cohort included 23,140 unweighted admissions in each coding-defined fixation category. After applying DISCWT, these corresponded to weighted national estimates of 40,490 cemented-category and 40,501 cementless-category primary TKA admissions. Coding-defined cementless-category TKA was associated with a lower weighted 90-day readmission proportion compared with cemented-category TKA (5.17% vs 5.76%; OR 0.89, 95% CI 0.84–0.95; <i>p</i> &lt; 0.001), as well as lower weighted proportions of blood loss anemia (11.28% vs 13.13%; OR 0.84, 95% CI 0.81–0.88; <i>p</i> &lt; 0.001) and any in-hospital complication (13.55% vs 15.36%; OR 0.86, 95% CI 0.83–0.90; <i>p</i> &lt; 0.001). Intraoperative fracture was more frequent in the cementless-category group (0.30% vs 0.18%; OR 1.67, 95% CI 1.25–2.23; <i>p</i> = 0.001). Blood transfusion rates were comparable between cohorts. Among readmitted patients, grouped primary readmission diagnoses and grouped principal procedures were heterogeneous and included infectious, wound-related, thromboembolic, cardiopulmonary, gastrointestinal, renal/urinary, mechanical/fracture-related, and other medical categories. Knee revision-related procedures represented only a minority of readmission procedures. In the revised age-centered interaction analysis, the fixation-category association at age 70&#xa0;years was not statistically significant, while the fixation-category by age interaction remained significant.</p> Conclusions <p>In this U.S. nationwide propensity-matched administrative analysis of elective unilateral primary TKA, coding-defined cementless-category and cemented-category admissions demonstrated modest differences in selected early complications and 90-day readmission patterns. These findings characterize short-term administrative outcomes and should be interpreted in the context of coding-based fixation classification and the absence of implant-level, radiographic, functional, and long-term survivorship data.</p> Levels of Evidence

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Ninety-day readmission and early complications after coding-defined cementless-category versus cemented-category primary total knee arthroplasty

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  • 发表日期：

    2026年8月5日

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  • David Maman,
  • Yaniv Steinfeld,
  • Yaron Berkovich

摘要

Background

Use of cementless total knee arthroplasty (TKA) has increased in recent years, but contemporary short-term administrative comparisons with cemented fixation remain limited. This study compared 90-day readmission and early postoperative complications after ICD-10-PCS coding-defined cementless-category versus cemented-category primary TKA using a large U.S. administrative readmission database.

Methods

The 2020–2022 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD) was queried for adults undergoing elective unilateral primary TKA for osteoarthritis. Only cases performed on hospital day 0 using common cemented and cementless ICD-10-PCS procedure codes were included. Fixation category was defined using ICD-10-PCS administrative procedure coding and was analyzed as coding-defined cementless-category versus cemented-category primary TKA. Non-elective admissions, bilateral procedures, revision or reoperation cases, fracture-, malignancy-, infection-, and COVID-19-related admissions, and index discharges after September were excluded. Readmissions involving contralateral knee arthroplasty were also excluded. Propensity-score matching was performed on the unweighted analytic sample, and DISCWT was applied after matching to generate weighted national estimates and proportions. The primary outcome was 90-day all-cause readmission. Secondary outcomes included intraoperative fracture, blood loss anemia, blood transfusion, stratified in-hospital complications, readmission burden, grouped primary causes of readmission, and grouped principal procedures performed during readmission.

Results

The 1:1 matched analytic cohort included 23,140 unweighted admissions in each coding-defined fixation category. After applying DISCWT, these corresponded to weighted national estimates of 40,490 cemented-category and 40,501 cementless-category primary TKA admissions. Coding-defined cementless-category TKA was associated with a lower weighted 90-day readmission proportion compared with cemented-category TKA (5.17% vs 5.76%; OR 0.89, 95% CI 0.84–0.95; p < 0.001), as well as lower weighted proportions of blood loss anemia (11.28% vs 13.13%; OR 0.84, 95% CI 0.81–0.88; p < 0.001) and any in-hospital complication (13.55% vs 15.36%; OR 0.86, 95% CI 0.83–0.90; p < 0.001). Intraoperative fracture was more frequent in the cementless-category group (0.30% vs 0.18%; OR 1.67, 95% CI 1.25–2.23; p = 0.001). Blood transfusion rates were comparable between cohorts. Among readmitted patients, grouped primary readmission diagnoses and grouped principal procedures were heterogeneous and included infectious, wound-related, thromboembolic, cardiopulmonary, gastrointestinal, renal/urinary, mechanical/fracture-related, and other medical categories. Knee revision-related procedures represented only a minority of readmission procedures. In the revised age-centered interaction analysis, the fixation-category association at age 70 years was not statistically significant, while the fixation-category by age interaction remained significant.

Conclusions

In this U.S. nationwide propensity-matched administrative analysis of elective unilateral primary TKA, coding-defined cementless-category and cemented-category admissions demonstrated modest differences in selected early complications and 90-day readmission patterns. These findings characterize short-term administrative outcomes and should be interpreted in the context of coding-based fixation classification and the absence of implant-level, radiographic, functional, and long-term survivorship data.

Levels of Evidence