{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:17:42Z","timestamp":1787015862690,"version":"build-2736575974"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,4,4]],"date-time":"2021-04-04T00:00:00Z","timestamp":1617494400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aim of this study was to investigate whether subclinical hypothyroidism could increase the risk of postoperative complications in patients undergoing primary total knee arthroplasty (TKA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective case\u2010control study of 796 patients undergoing primary TKA between January 2015 and January 2020 was performed. A total of 700 patients (87.9%) were female and the average age of included patients was 65.0\u2009years, with a standard deviation of 5.6. The participants who had subclinical hypothyroidism were referred to as the case group, while those without abnormal thyrotropin (TSH) were included in the control group (matched for age and gender). The fasting plasma levels of TSH were tested in the morning in all patients. The diagnosis of subclinical hypothyroidism was completed by a senior endocrinologist based on laboratory tests; namely, a serum TSH\u2009\u2265\u20095\u2009mu\/L and normal free thyroxine (FT4). Subclinical hypothyroidism was further described as mild (TSH\u2009&lt;\u200910\u2009mu\/L) or severe (TSH\u2009\u2265\u200910\u2009mu\/L). The incidence of 90\u2010day postoperative complications was compared between two cohorts. Logistic regression analysis was used for the risk factors of 90\u2010day postoperative complications following TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 398 patients had a diagnosis of subclinical hypothyroidism. Among them, 275 cases (69.1%) were described as mild (79 patients [19.8%] with low FT4 and 196 patients [49.2%] with normal FT4 in the repeated test) and 123 cases (30.9%) as severe subclinical hypothyroidism. Of the 196 patients (49.2%) with mild subclinical hypothyroidism and normal FT4, 63 patients (15.8%) had symptoms before surgery. Patients were followed up for an average duration of 25.4\u2009months (6 to 43\u2009months). A total of 265 patients (66.6%) received preoperative treatment for subclinical hypothyroidism, with an average therapy time of 9.2\u2009months. There were 162 patients (40.7%) with positive autoantibodies to thyroid peroxidase (anti\u2010TPO). There were no statistically significant differences in baseline data between cohorts (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u20090.05). As for the cumulative 90\u2010day outcomes, subclinical hypothyroidism increased the incidences of both medical and surgical complications following primary TKA compared to those without this condition (11.6%\n                      <jats:italic>vs<\/jats:italic>\n                      7.2%, OR = 1.55, 95% confidence interval [CI] = 1.47\u20131.62,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). Subclinical hypothyroidism caused patients to suffer increased total incidence of readmission within the first 90\u2009days after discharge when compared to those without this condition (20.61%\n                      <jats:italic>vs<\/jats:italic>\n                      14.15%, OR = 1.45, 95% CI = 1.41\u20131.49,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Controlling for preoperative and intraoperative variables, the patients with TSH\u2009\u2265\u200910\u2009mu\/L and positive anti\u2010TPO and those without corrected subclinical hypothyroid and thyroid hormone supplementation were more likely to experience postoperative complications within 90\u2009days of TKA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Subclinical hypothyroidism might increase the risk of postoperative complications within 90\u2009days of TKA, especially for the patients with TSH\u2009\u2265\u200910\u2009mu\/L and positive anti\u2010TPO and those without corrected subclinical hypothyroid and thyroid hormone supplementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.12934","type":"journal-article","created":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T02:28:30Z","timestamp":1617589710000},"page":"932-941","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Subclinical Hypothyroidism Affects Postoperative Outcome of Patients Undergoing Total Knee Arthroplasty"],"prefix":"10.1111","volume":"13","author":[{"given":"Wen","family":"Jing","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences  No. 99, Longcheng Street Taiyuan City Shanxi Province 030032 China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6040-7537","authenticated-orcid":false,"given":"Gong","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, China\u2010Japan Friendship Hospital China\u2010Japan Friendship Hospital, Peking Union Medica College, Chinese Academy of Medical College  No.2 Yin Hua East Street Beijing 100029 China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery the 980th Hospital of Joint Logistic Support Force of PLA.  Shijiazhuang He Bei Province 050000 China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Ping","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, China\u2010Japan Friendship Hospital China\u2010Japan Friendship Hospital, Peking Union Medica College, Chinese Academy of Medical College  No.2 Yin Hua East Street Beijing 100029 China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tan","family":"Mingsheng","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, China\u2010Japan Friendship Hospital China\u2010Japan Friendship Hospital, Peking Union Medica College, Chinese Academy of Medical College  No.2 Yin Hua East Street Beijing 100029 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