Low muscle mass is an independent risk factor for postoperative blood transfusion in total knee arthroplasty: a retrospective, propensity score-matched cohort study

BMC Geriatr. 2022 Mar 17;22(1):218. doi: 10.1186/s12877-022-02903-0.


Background: Sarcopenia, an age-related loss of skeletal muscle mass and function, is correlated with adverse outcomes after some surgeries. This study examined the characteristics of sarcopenic patients undergoing primary total knee arthroplasty (TKA), and identified low muscle mass as an independent risk factor for postoperative TKA complications.

Methods: A retrospective cohort study examined 452 patients who underwent TKA. The skeletal muscle index (SMI) was obtained via bioelectrical impedance analysis (BIA), along with demographics, the Charlson Comorbidity Index, and medication, laboratory and operative data for 2018-2021. Patients were categorized into normal (n = 417) and sarcopenic (n = 35) groups using the SMI cut-off suggested by the Asian Working Group for Sarcopenia 2019 (males, < 7.0 kg/m2; females, < 5.7 kg/m2). Three postoperative complications were analysed: blood transfusion, delirium, and acute kidney injury (AKI). Baseline characteristics were propensity score-matched to address potential bias and confounding factors.

Results: The proportion of sarcopenic patients in primary TKA was 7.7% (35/452). The sarcopenic group had a lower preoperative haemoglobin (12.18 ± 1.20 vs. 13.04 ± 1.73 g/dL, p = 0.004) and total protein (6.73 ± 0.42 vs. 7.06 ± 0.44 mg/dL, p = 0.001). Propensity scoring matching and logistic regression showed that more patients in the sarcopenic group received postoperative blood transfusions (OR = 6.60, 95% CI: 1.57-45.5, p = 0.021); there was no significant difference in AKI or delirium. Univariate receiver operating characteristic curve analysis of the propensity-matched group, to determine the predictive value of SMI for postoperative transfusion, gave an AUC of 0.797 (0.633-0.96) and SMI cut-off of 5.6 kg/m2.

Conclusions: Low muscle mass determined by BIA was an independent risk factor for postoperative transfusion in TKA. Multifrequency BIA can serve as a screening tool for sarcopenia that may influence the orthopaedic decision-making process or treatment planning in patients with sarcopenia undergoing primary TKA.

Level of evidence: III, retrospective cohort study.

Keywords: Bioelectrical impedance analysis; Complication; Sarcopenia; Skeletal muscle index; Total knee arthroplasty; Transfusion.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury* / complications
  • Arthroplasty, Replacement, Knee* / adverse effects
  • Blood Transfusion
  • Cohort Studies
  • Delirium* / etiology
  • Female
  • Humans
  • Male
  • Muscle, Skeletal
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Propensity Score
  • Retrospective Studies
  • Risk Factors
  • Sarcopenia* / diagnosis
  • Sarcopenia* / epidemiology
  • Sarcopenia* / etiology