Improved outcomes seen with joint replacement surgery in EDS: Study
But patients face higher risk of complications than those without EDS
People with Ehlers-Danlos syndrome (EDS) can safely undergo total joint replacement surgery and achieve significant gains, among them “[improved] quality of life in … patients who had marked arthritis,” according to a new review.
However, EDS patients who have this procedure — known as arthroplasty, it’s when a joint such as a hip or knee is replaced with a prosthesis — also face a higher risk of implant-related complications compared with individuals without these connective tissue conditions, the meta-analysis of published studies found.
The data showed that people with EDS are at a higher risk of requiring a second surgery, and also have a greater chance of implant instability. Specifically, those who underwent hip surgery faced a greater risk of their implant loosening, while knee joint replacement was linked to a higher risk of an implant fracture and wound complications.
Overall, “patients who have Ehlers-Danlos have an increased risk of implant-related complications following TJA [total joint arthroplasty],” the researchers wrote.
The team noted, however, that “despite the increased risks, most EDS patients have excellent clinical outcomes following” total joint replacement therapy.
Their study, “Outcomes of Total Joint Arthroplasty in Patients Who Have Ehlers-Danlos Syndrome: A Systematic Review and Meta-Analysis,” was published in The Journal of Arthroplasty.
Study is first to analyze joint replacement surgery outcomes in EDS patients
EDS comprises a group of genetic disorders that impact connective tissues, which play a crucial role in providing support and structure to the body’s tissues and organs. Common symptoms include joints that are unusually flexible or overly mobile, as well as delicate, fragile skin that is prone to injury.
People with EDS often develop arthritis, a type of joint damage, early in life. But EDS-related complications make surgery considerations complex when patients seek replacement of damaged joints in the hips or knees.
According to the researchers, however, “there is little comprehensive data … regarding the outcomes of total joint arthroplasty (TJA) in this patient population, making [surgical] management and decision-making difficult.”
That lack of data led scientists at the Hospital for Special Surgery and Weill Cornell Medicine in New York to conduct a systematic review of published studies. The team searched online databases for studies between 2004 and 2024 reporting on EDS patients who underwent total hip or knee replacement.
Their systematic review and meta-analysis is “the first to provide a comprehensive analysis of contemporary literature regarding outcomes in patients who have EDS undergoing [hip or knee surgery],” according to the team.
The seven studies used in the meta-analysis involved EDS and non-EDS patients with osteoarthritis, the most common type of arthritis. Most matched patients for age, sex, and body mass index, a ratio of weight to height. The average age of the patients ranged from 43 to 57, and most were women. Patients were followed for three to 24 months.
The main goal of the study was to analyze the postoperative complications of EDS patients following TJA. To this end, the team assessed the rate of surgical revisions — meaning second surgeries — after the procedure due to any cause, hospital readmissions, and complications, both medical and surgical, between EDS and non-EDS patients.
A total of 7.6% of EDS patients who underwent hip replacement required a second surgery compared with 1.5% of non-EDS patients, a difference deemed statistically significant. The risk for a follow-up surgery due to any cause was 2.4 times higher in EDS patients.
Regarding knee surgery, the pooled all-cause rate for follow-up surgery was 8.4% in EDS patients and 5.7% in non-EDS patients, which also was a statistically significant difference. Specifically, there was a 1.54 times higher risk of needing a second surgery for EDS patients.
Nearly 3 times higher risk of fractures, instability found for EDS patients
A higher proportion of individuals with EDS (6.6%) reported instability and/or dislocation than non-EDS patients (3%), which represented a 3.2 times increased risk after hip surgery in EDS. No dislocation events were reported in patients who underwent knee replacement.
Instability rates also were higher among EDS patients who underwent total knee replacement (4.1% vs. 1.4%), representing a nearly three times higher risk among those with EDS.
In addition, implant loosening in the absence of an infection, known as aseptic loosening, was also significantly more common in EDS patients who underwent total hip replacement (7.1% vs. 1.7%), but not in those who underwent knee replacement.
EDS patients undergoing [joint replacement surgery] may benefit from careful planning with surgical techniques and constrained designs that minimize instability.
The rate of fractures affected a significantly higher number of EDS participants after knee replacement (1.4% vs. 0.48%), which translated to a 2.91 times greater risk. No such difference was seen in patients undergoing hip surgery.
Wound complications and/or hematoma, or blood collection in the joint, following knee arthroplasty also were significantly more likely, by 4.33 times, in EDS patients.
No differences were seen regarding the pooled rate of medical complications after hip or knee surgery comparing EDS with non-EDS patients, as well as in joint infections near the prosthetic, or the need for readmission.
Three studies included patient-reported outcome measures, one after hip arthroplasty and two following knee surgery. All studies reported significant improvements following surgery, with no differences between EDS and non-EDS patients.
Overall, these findings suggest that “EDS patients undergoing arthroplasty may benefit from careful planning with surgical techniques and constrained designs that minimize instability,” the study concluded, with the researchers noting that “surgeons may consider techniques to mitigate the risk of instability in these patients.”
About the Author
