Outcomes of Total Joint Arthroplasty in Patients Who Have Ehlers-Danlos Syndrome: A Systematic Review and Meta-Analysis.

BACKGROUND: Patients who have Ehlers-Danlos Syndrome (EDS), a group of connective tissue disorders characterized by aberrant collagen synthesis and processing, have an increased likelihood of requiring a total joint arthroplasty (TJA), including total hip arthroplasty or total knee arthroplasty (THA or TKA). This study aimed to synthesize outcomes following TJA in patients who have EDS.

METHODS: This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that described outcomes of TJA in EDS patients were searched from PubMed, Medline, The Cochrane Library, and Embase. Case series and cohort studies were included if they identified patients who had EDS who underwent either primary THA or TKA. Rates of reoperation and/or revision, instability or frank dislocation, aseptic loosening, periprosthetic fractures, periprosthetic joint infection, medical complications, wound complications, and readmissions were collected and compared to patients who do not have EDS. Individual pooled comparative meta-analysis was performed for each variable. Patient-reported outcome measures were collected and qualitatively described. The search yielded eight publications with 1,769 EDS patients (1,011 THA and 758 TKA) describing outcomes after TJA.

RESULTS: Following THA, EDS patients were at increased risk of all-cause revision (OR [odds ratio] = 2.40, P < 0.001), instability/dislocation (OR = 3.22, P < 0.001), and aseptic loosening (OR = 3.76, P < 0.001). Following TKA, EDS patients were at increased risk of all-cause revision (OR = 1.54, P = 0.006), instability (OR = 2.96, P < 0.001), periprosthetic fracture (OR = 2.91, P = 0.009), and wound complications/hematoma (OR = 2.91, P < 0.001). There were no differences in medical complications, periprosthetic joint infection, or readmission. The Patient-reported outcome measures were similar between the cohorts and significantly improved compared to the baselines.

CONCLUSIONS: Patients who have Ehlers-Danlos have an increased risk of implant-related complications following TJA. The EDS patients undergoing arthroplasty may benefit from careful planning with surgical techniques and constrained designs that minimize instability.