Does Obstructive Sleep Apnea Affect Complications or Patient-Reported Outcomes Following Primary Total Knee Arthroplasty? A Propensity-Matched Analysis.

BACKGROUND

Obstructive sleep apnea (OSA) affects more than 10% of adults. Prior studies have reported conflicting findings regarding the impact of OSA on postoperative outcomes following primary total knee arthroplasty (TKA), and few have examined patient-reported outcome measures (PROMs). This study aimed to compare PROMs and postoperative complications after primary TKA in patients who had and did not have OSA using a propensity-matched analysis.

METHODS

An institutional database identified 11,210 consecutive primary TKA cases; 5,189 patients had a minimum 2-year follow-up with both preoperative and postoperative PROMs. Propensity matching was performed at a 1:1 ratio based on age, sex, body mass index, and comorbidities. After matching, 1,119 patients who had OSA and 1,119 patients who did not have OSA were included. Medical complications at 90 days and surgical complications at one and two years were recorded. The absolute scores, delta scores, and minimal clinically important difference (MCID) were evaluated for the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a, PROMIS Global Health Physical, PROMIS Global Health Mental, and the Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form.

RESULTS

There were no significant differences in 90-day medical complications or 1- and 2-year surgical complications between cohorts (all P > 0.05). Patients who had OSA reported modestly lower absolute postoperative PROMs, whereas delta scores and MCID response distributions were similar. Patients who had documented continuous positive airway pressure use also reported similar improvements in all PROM domains.

CONCLUSIONS

Preoperative OSA was not associated with increased complications after primary TKA. Despite lower absolute PROMs, patients who had OSA demonstrated similar improvement and MCID achievement rates, indicating preserved patient-perceived benefit after TKA.