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Patients With Moderate to Severe Dementia Who Undergo Elective TKA Face Elevated Risks of Death, Delirium, and Intensive Interventions: A Large, Propensity-weighted Database Study
Taylor D. Ottesen, Lingwei Xiang, Rachel Adler, Kaitlyn E. Holly, Clancy J. Clark, Karen Sepucha, Samir K. Shah, Dae Hyun Kim et al.. Clinical Orthopaedics and Related Research, 2025-05-13
Topic: Risk, prevention and care in population studies
After adjusting for potentially confounding variables such as age, gender, and comorbidities, we found that individuals with mild dementia (HR 1.74 [95% confidence interval (CI) 1.12 to 2.70]; p = 0.01) and moderate to severe dementia (HR 3.05 [95% CI 1.80 to 5.17]; p < 0.001) both demonstrated elevated hazards of death compared with patients without dementia. Patients with mild dementia (HR 4.25 [95% CI 2.59 to 5.03]; p < 0.001) and moderate to severe dementia (HR 6.40 [95% CI 5.18 to 7.92]; p < 0.001) exhibited elevated hazards of delirium, and those with moderate to severe dementia were found to have greater hazards of one or more intensive interventions (HR 3.24 [95% CI 1.76 to 5.96]; p < 0.001). We observed elevations in the risk of death and delirium in patients after TKA, irrespective of the severity of dementia and marked elevations in the likelihood of intensive interventions after surgery for those with moderate to severe dementia. We believe that TKA in patients with mild dementia should only proceed after clear communication about the increased risk of death, as well as effective management of chronic medical conditions and prophylactic enhancement of cognitive reserves. Performing TKA in patients with moderate to severe dementia might only be indicated in exceptional humanitarian circumstances. LEVEL OF EVIDENCE: Level III, therapeutic study.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Ottesen, T. D., Xiang, L., Adler, R., Holly, K. E., Clark, C. J., Sepucha, K., et al. (2025). Patients With Moderate to Severe Dementia Who Undergo Elective TKA Face Elevated Risks of Death, Delirium, and Intensive Interventions: A Large, Propensity-weighted Database Study. Clinical Orthopaedics and Related Research. https://doi.org/10.1097/corr.0000000000003542
Vancouver
Ottesen TD, Xiang L, Adler R, Holly KE, Clark CJ, Sepucha K, et al. Patients With Moderate to Severe Dementia Who Undergo Elective TKA Face Elevated Risks of Death, Delirium, and Intensive Interventions: A Large, Propensity-weighted Database Study. Clinical Orthopaedics and Related Research. 2025. doi:10.1097/corr.0000000000003542. PMID: 40359903.
BibTeX
@article{ottesen2025-40359903,
author = {Ottesen, Taylor D. and Xiang, Lingwei and Adler, Rachel and Holly, Kaitlyn E. and Clark, Clancy J. and Sepucha, Karen and Shah, Samir K. and Kim, Dae Hyun and others},
title = {{Patients With Moderate to Severe Dementia Who Undergo Elective TKA Face Elevated Risks of Death, Delirium, and Intensive Interventions: A Large, Propensity-weighted Database Study}},
journal = {Clinical Orthopaedics and Related Research},
year = {2025},
doi = {10.1097/corr.0000000000003542},
pmid = {40359903},
url = {https://doi.org/10.1097/corr.0000000000003542}
}
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Key findings
- After adjusting for potentially confounding variables such as age, gender, and comorbidities, we found that individuals with mild dementia (HR 1.74 [95% confidence interval (CI) 1.12 to 2.70]; p = 0.01) and moderate to severe dementia (HR 3.05 [95% CI 1.80 to 5.17]; p < 0.001) both demonstrated elevated hazards of death compared with patients without dementia.
- Patients with mild dementia (HR 4.25 [95% CI 2.59 to 5.03]; p < 0.001) and moderate to severe dementia (HR 6.40 [95% CI 5.18 to 7.92]; p < 0.001) exhibited elevated hazards of delirium, and those with moderate to severe dementia were found to have greater hazards of one or more intensive interventions (HR 3.24 [95% CI 1.76 to 5.96]; p < 0.001).
- We observed elevations in the risk of death and delirium in patients after TKA, irrespective of the severity of dementia and marked elevations in the likelihood of intensive interventions after surgery for those with moderate to severe dementia.
- We believe that TKA in patients with mild dementia should only proceed after clear communication about the increased risk of death, as well as effective management of chronic medical conditions and prophylactic enhancement of cognitive reserves.
- Performing TKA in patients with moderate to severe dementia might only be indicated in exceptional humanitarian circumstances.
Why it matters
This large database study found that patients with moderate to severe dementia who undergo elective total knee arthroplasty face elevated risks of death, delirium, and intensive interventions. The authors suggest that TKA in patients with moderate to severe dementia might only be indicated in exceptional humanitarian circumstances.
Study details
- Participants156,596
- Effect sizeHR 1.74; HR 3.05; HR 4.25
- Evidence strengthModerate
How this study scored 54/100
Published in a peer-reviewed journal. Scored zero for study design and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Clinical Orthopaedics and Related Research) |
| Journal's citation record | 3 / 4 | Clinical Orthopaedics and Related Research: journal h-index 350 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 4 / 4 | 156,596 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 6 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 5.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 6 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Andrew J. Schoenfeld: h-index 64 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | Harvard University: institution h-index 3,235 (OpenAlex) |
| Multicenter collaboration | 2 / 3 | OpenAlex lists 7 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40359903) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 54 / 100 | — |
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