Hypothyroidism Is Associated With Increased Medical and Surgical Complications Following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis Publisher Pubmed



Shaker F ; Pahlevan Fallahy MT ; Asgari AM ; Behrouzieh S ; Borazjani R ; Kreuzer SW
Source: Journal of Arthroplasty Published:2026

Abstract

Background Total joint arthroplasty (TJA) is an effective treatment for end-stage osteoarthritis. However, hypothyroidism, even when medically controlled, has been linked to higher rates of postoperative complications. This meta-analysis assessed the impact of hypothyroidism on outcomes after total hip or total knee arthroplasty. Methods A comprehensive search was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines across PubMed, Embase, Web of Science, and Scopus through October 2024. Studies comparing outcomes after TJA by thyroid status (18 studies, 4,622,479 TJAs) were included. Results Hypothyroidism significantly increases the risks of periprosthetic joint infection (odds ratio (OR): 1.69; 95% confidence interval (CI): 1.07 to 2.66, P = 0.01), periprosthetic fracture (OR: 1.26; 95% CI: 1.07 to 1.48, P < 0.01), blood transfusion (OR: 1.68; 95% CI: 1.20 to 2.35, P < 0.01), acute renal failure (OR: 1.23; 95% CI: 1.09 to 1.38, P < 0.01), nonhome discharge (OR: 1.47; 95% CI: 1.05 to 2.06, P = 0.025), and anemia (OR: 1.25; 95% CI: 1.13 to 1.37, P < 0.01). In total knee arthroplasty subgroup, hypothyroidism increased the odds of mortality (OR: 1.63; 95% CI: 1.15 to 2.32, P = 0.006), periprosthetic joint infection (OR: 1.53; 95% CI: 1.29 to 1.81, P < 0.001), blood transfusion (OR: 1.45; 95% CI: 1.38 to 1.52, P < 0.001), anemia (OR: 1.29; 95% CI: 1.20 to 1.39, P < 0.001), deep venous thrombosis (OR: 1.18; 95% CI: 1.02 to 1.37, P = 0.024), pulmonary emboli (OR: 1.50; 95% CI: 1.07 to 2.10, P = 0.018), cardiac complications (OR: 1.21; 95% CI: 1.04 to 1.42, P = 0.014), intubation (OR: 1.44; 95% CI: 1.06 to 1.96, P = 0.018), and renal complications (OR: 1.32; 95% CI: 1.16 to 1.49, P < 0.001). Readmission rate was higher (OR: 1.40; 95% CI: 1.09 to 1.79, P = 0.009) after total hip arthroplasties. Other outcomes, including wound complications, dislocation, mechanical loosening, hospital stay, and cost, were comparable between groups. Conclusions Hypothyroidism is associated with increased risks of some medical and surgical complications following TJA; therefore, studies should evaluate whether optimizing thyroid function can reduce these risks. © 2025 Elsevier Inc.