{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:52:38Z","timestamp":1791366758877,"version":"4.3.1"},"reference-count":34,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>A significant population of patients undergoing total knee arthroplasty (TKA) concomitantly have atrial fibrillation (AF). Previous studies have examined acute postoperative complications; however, the long-term impact of pre-existing AF on surgical outcomes after TKA remains underexplored. This study aimed to evaluate 2-, 5-, and 10-year risk and indications for revision among patients with AF undergoing TKA. The TriNetX database was utilized for this retrospective cohort study. The primary outcome was 2-, 5-, and 10-year risk of revision following primary TKA among patients with and without pre-existing AF. The AF and control cohorts were 1:1 propensity matched by age, sex, race, clinical comorbidities, and anticoagulant and aspirin use. Covariate balance after matching was assessed using standardized mean differences (SMDs). Cox proportional hazards models and Kaplan-Meier survival estimates were used to evaluate all-cause revision and specific complications. Results were reported as hazard ratios (HRs) with 95% confidence intervals (CIs), survival probabilities, and p-values. A p-value of &lt;\u20090.05 was considered statistically significant. Patients with pre-existing AF (n\u2009=\u200924,671) had a significantly higher risk of all-cause revision at 2 years (HR 1.27, 95% CI: 1.13\u20131.43, p\u2009&lt;\u20090.0001), 5 years (HR 1.23, 95% CI: 1.11\u20131.37, p\u2009&lt;\u20090.0001), and 10 years (HR 1.23, 95% CI: 1.12\u20131.35, p\u2009&lt;\u20090.0001) post-TKA compared to matched controls (n\u2009=\u200924,671). The AF cohort demonstrated increased risk of periprosthetic joint infection (PJI) (HR 1.33, 95% CI: 1.22\u20131.44, p\u2009&lt;\u20090.0001) while showing decreased incidence of arthrofibrosis (HR 0.85, 95% CI: 0.80\u20130.91, p\u2009&lt;\u20090.0001). No significant difference in periprosthetic fracture, mechanical loosening, osteolysis, or articular wear was observed. Pre-existing AF is associated with increased long-term risk of revision following TKA up to 10 years postoperatively compared to matched controls, even after matching for comorbidity burden and anticoagulant use. These findings should be interpreted cautiously in the context of modest effect sizes and limitations inherent within the TriNetX database. Future studies should examine whether perioperative anticoagulation management strategies influence long-term postoperative complications in patients with AF undergoing TKA.<\/jats:p>","DOI":"10.1055\/a-2968-5946","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:38:36Z","timestamp":1791362316000},"source":"Crossref","is-referenced-by-count":0,"title":["Pre-existing Atrial Fibrillation and Long-term Outcomes Following Total Knee Arthroplasty"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4719-0170","authenticated-orcid":false,"given":"Elisabeth S.","family":"Merten","sequence":"additional","affiliation":[{"name":"The George Washington University School of Medicine and Health Sciences, District of Columbia, United States","place":["Washington"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackson W.","family":"Durbin","sequence":"additional","affiliation":[{"name":"The George Washington University School of Medicine and Health Sciences, District of Columbia, United States","place":["Washington"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Garcia","sequence":"additional","affiliation":[{"name":"The University of Arizona College of Medicine, Tucson Arizona, United States","place":["Tucson"],"department":["Department of Orthopaedic Surgery"]},{"name":"Johns Hopkins School of Medicine, Maryland, United States","place":["Baltimore"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy Y.","family":"Zhao","sequence":"additional","affiliation":[{"name":"The George Washington University School of Medicine and Health Sciences, District of Columbia, United States","place":["Washington"],"department":["Department of Orthopaedic Surgery"]},{"name":"Johns Hopkins School of Medicine, Maryland, United States","place":["Baltimore"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aribah","family":"Shah","sequence":"additional","affiliation":[{"name":"The George Washington University School of Medicine and Health Sciences, District of Columbia, United States","place":["Washington"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Williams","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine, Maryland, United States","place":["Baltimore"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Siegel","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine, Maryland, United States","place":["Baltimore"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y.","family":"Golladay","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University School of Medicine, Virginia, United States","place":["Richmond"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savyasachi C.","family":"Thakkar","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine, Maryland, United States","place":["Baltimore"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"e22.00112","DOI":"10.2106\/JBJS.OA.22.00112","article-title":"Projections and epidemiology of primary hip and knee arthroplasty in Medicare patients to 2040\u20132060","volume":"8","author":"I Shichman","year":"2023","journal-title":"JBJS Open Access"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"E60","DOI":"10.5888\/pcd14.160495","article-title":"Comorbid arthritis is associated with lower health-related quality of life in older adults with other chronic conditions, United States, 2013\u20132014","volume":"14","author":"E Havens","year":"2017","journal-title":"Prev Chronic Dis"},{"issue":"07","key":"ref3","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1002\/acr.24008","article-title":"Comorbidities in osteoarthritis: a systematic review and meta-analysis of observational studies","volume":"72","author":"S Swain","year":"2020","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s42836-023-00175-6","article-title":"Epidemiology of primary and revision total knee arthroplasty: analysis of demographics, comorbidities and outcomes from the national inpatient sample","volume":"5","author":"F H Nham","year":"2023","journal-title":"Arthroplasty"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1007\/s11999-011-2043-3","article-title":"Patient-related risk factors for postoperative mortality and periprosthetic joint infection in Medicare patients undergoing TKA","volume":"470","author":"K J Bozic","year":"2012","journal-title":"Clin Orthop Relat Res"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"265","DOI":"10.4055\/cios23224","article-title":"Cardiovascular disease in total knee arthroplasty: an analysis of hospital outcomes, complications, and mortality","volume":"16","author":"S Okpara","year":"2024","journal-title":"Clin Orthop Surg"},{"issue":"09","key":"ref7","doi-asserted-by":"crossref","first-page":"S191","DOI":"10.1016\/j.arth.2024.03.025","article-title":"The impact of cardiac arrhythmias on total knee arthroplasty outcomes","volume":"39","author":"T Kotzur","year":"2024","journal-title":"J Arthroplasty"},{"issue":"11","key":"ref9","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1038\/nrcardio.2014.118","article-title":"Global epidemiology of atrial fibrillation","volume":"11","author":"F Rahman","year":"2014","journal-title":"Nat Rev Cardiol"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1177\/1747493019897870","article-title":"Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge","volume":"16","author":"G Lippi","year":"2021","journal-title":"Int J Stroke"},{"issue":"07","key":"ref11","doi-asserted-by":"crossref","first-page":"e006350","DOI":"10.1161\/CIRCEP.118.006350","article-title":"Lifetime risk of atrial fibrillation by race and socioeconomic status","volume":"11","author":"L Mou","year":"2018","journal-title":"Circ Arrhythm Electrophysiol"},{"issue":"08","key":"ref12","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1016\/j.amjcard.2013.05.063","article-title":"Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population","volume":"112","author":"S Colilla","year":"2013","journal-title":"Am J Cardiol"},{"issue":"16","key":"ref13","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1016\/j.jacc.2024.07.014","article-title":"Minimum national prevalence of diagnosed atrial fibrillation inferred from California acute care facilities","volume":"84","author":"J J Noubiap","year":"2024","journal-title":"J Am Coll Cardiol"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1136\/heartjnl-2020-318480","article-title":"Atrial fibrillation: global burdens and global opportunities","volume":"107","author":"J Kornej","year":"2021","journal-title":"Heart"},{"issue":"13","key":"ref15","doi-asserted-by":"crossref","first-page":"e017559","DOI":"10.1161\/JAHA.120.017559","article-title":"Direct oral anticoagulant use: a practical guide to common clinical challenges","volume":"9","author":"A Chen","year":"2020","journal-title":"J Am Heart Assoc"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.arth.2023.07.011","article-title":"Patients who have pre-existing atrial fibrillation require increased postoperative care following total joint arthroplasty","volume":"39","author":"C A Reynolds","year":"2024","journal-title":"J Arthroplasty"},{"issue":"04","key":"ref17","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/j.arth.2024.09.038","article-title":"Chronic anticoagulation in patients who have atrial fibrillation undergoing outpatient total knee arthroplasty: a retrospective matched cohort study","volume":"40","author":"M Singh","year":"2025","journal-title":"J Arthroplasty"},{"issue":"05","key":"ref18","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.jos.2016.05.002","article-title":"Impact of atrial fibrillation on postoperative outcomes after total knee arthroplasty\u2014a retrospective study","volume":"21","author":"G Long","year":"2016","journal-title":"J Orthop Sci"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jor.2024.10.054","article-title":"Anticoagulation in patients with atrial fibrillation undergoing inpatient total knee arthroplasty: a matched analysis","volume":"63","author":"M Daher","year":"2024","journal-title":"J Orthop"},{"issue":"07","key":"ref20","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1007\/s11999-008-0209-4","article-title":"Periprosthetic joint infection: the incidence, timing, and predisposing factors","volume":"466","author":"L Pulido","year":"2008","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.arth.2013.04.015","article-title":"Risk factors for periprosthetic joint infection following primary total hip arthroplasty: a case control study","volume":"29","author":"K J Bozic","year":"2014","journal-title":"J Arthroplasty"},{"issue":"19","key":"ref22","doi-asserted-by":"crossref","first-page":"e351","DOI":"10.1161\/CIR.0000000000001285","article-title":"2024 AHA\/ACC\/ACS\/ASNC\/HRS\/SCA\/SCCT\/SCMR\/SVM guideline for perioperative cardiovascular management for noncardiac surgery: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"150","author":"A Thompson","year":"2024","journal-title":"Circulation"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1111\/jce.15759","article-title":"Atrial fibrillation: epidemiology, pathophysiology, and clinical complications (literature review)","volume":"34","author":"K A Bizhanov","year":"2023","journal-title":"J Cardiovasc Electrophysiol"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"k1453","DOI":"10.1136\/bmj.k1453","article-title":"Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham Heart Study","volume":"361","author":"L Staerk","year":"2018","journal-title":"BMJ"},{"issue":"06","key":"ref25","doi-asserted-by":"crossref","first-page":"e007943","DOI":"10.1161\/JAHA.117.007943","article-title":"Provider specialty, anticoagulation prescription patterns, and stroke risk in atrial fibrillation","volume":"7","author":"W T O'Neal","year":"2018","journal-title":"J Am Heart Assoc"},{"issue":"04","key":"ref26","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.joca.2023.12.005","article-title":"Inflammation in osteoarthritis: our view on its presence and involvement in disease development over the years","volume":"32","author":"M HJ van den Bosch","year":"2024","journal-title":"Osteoarthritis Cartilage"},{"issue":"01","key":"ref27","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1186\/s13018-024-05104-0","article-title":"Assessing the predictive value of pre- and post-operative inflammatory markers in patients undergoing total knee arthroplasty","volume":"19","author":"K A Ali","year":"2024","journal-title":"J Orthop Surg Res"},{"issue":"16","key":"ref28","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.2106\/JBJS.17.01110","article-title":"Type of anticoagulant used after total knee arthroplasty affects the rate of knee manipulation for postoperative stiffness","volume":"100","author":"C A Kahlenberg","year":"2018","journal-title":"J Bone Joint Surg Am"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"101690","DOI":"10.1016\/j.artd.2025.101690","article-title":"The effect of chronic anticoagulation on early postoperative outcomes following total knee arthroplasty: a TriNetX database study","volume":"33","author":"A H Johnson","year":"2025","journal-title":"Arthroplast Today"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"afab264","DOI":"10.1093\/ageing\/afab264","article-title":"Fracture risks in patients with atrial fibrillation treated with different oral anticoagulants: a meta-analysis and systematic review","volume":"51","author":"X Xie","year":"2022","journal-title":"Age Ageing"},{"issue":"01","key":"ref31","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.amjmed.2022.08.006","article-title":"Prosthetic joint infections of the hip and knee among the elderly: a retrospective study","volume":"136","author":"A Spichler-Moffarah","year":"2023","journal-title":"Am J Med"},{"issue":"05","key":"ref32","doi-asserted-by":"crossref","first-page":"e20.00194","DOI":"10.2106\/JBJS.RVW.20.00194","article-title":"Effects of anticoagulant medication on bone-healing","volume":"9","author":"A J Butler","year":"2021","journal-title":"JBJS Rev"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"139","DOI":"10.11005\/jbm.2021.28.2.139","article-title":"A network meta-analysis comparing osteoporotic fracture among different direct oral anticoagulants and vitamin K antagonists in patients with atrial fibrillation","volume":"28","author":"D Khanra","year":"2021","journal-title":"J Bone Metab"},{"issue":"10","key":"ref34","doi-asserted-by":"crossref","first-page":"3401","DOI":"10.1016\/j.arth.2021.05.022","article-title":"Perioperative statin use may reduce postoperative arrhythmia rates after total joint arthroplasty","volume":"36","author":"J C Bonano","year":"2021","journal-title":"J Arthroplasty"},{"issue":"09","key":"ref35","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1111\/j.1540-8167.2010.01774.x","article-title":"Update on the association of inflammation and atrial fibrillation","volume":"21","author":"P Patel","year":"2010","journal-title":"J Cardiovasc Electrophysiol"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2968-5946.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:13:51Z","timestamp":1791364431000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2968-5946"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":34,"URL":"https:\/\/doi.org\/10.1055\/a-2968-5946","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]}}}