Epidemiological and Surgical Profile of Total Knee Arthroplasty in Public Health Services in the State of São Paulo: A Multicenter Study
D.U. Munhoz, P.N. Giglio, A.B. Mestriner, A.R.C. Segalla, M.K. Demange, R.G. GobbiObjective:
To describe the epidemiological and surgical profile of patients undergoing primary total knee arthroplasty (TKA) in public hospitals in the state of São Paulo and to assess postoperative complications and revision rates.
Methods:
This multicenter, retrospective observational study included patients who underwent primary TKA between 2008 and 2018 in four tertiary public hospitals. Demographic data, comorbidities, surgical characteristics, in-hospital outcomes, and postoperative complications were collected from medical records using a standardized REDCap database. The primary outcome was the rate of revision surgery over a median follow-up of three years. Secondary outcomes included length of hospital stay, ICU admission, early postoperative complications, and mortality.
Results:
A total of 433 patients (534 procedures) were analyzed. The median age was 68 years, and 71.1% were women. Osteoarthritis was the leading indication (95.4%). The burden of comorbidities was substantial, particularly diabetes mellitus and peripheral vascular disease. Median hospital stay was four days, and 42.7% of patients required ICU admission. Early postoperative complications occurred in 6.2% of cases. During a median follow-up of 3.1 years, 19.7% of patients experienced prosthesis-related complications, and the overall revision rate was 14.6%. Surgical site infection was the most frequent late complication (7.3%).
Conclusion:
Despite an epidemiological profile comparable to international series, patients treated in the Brazilian public health system present a high burden of comorbidities and elevated rates of infection and revision. These findings emphasize the need for integrated strategies focused on preoperative optimization.