{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T21:26:51Z","timestamp":1792272411928,"version":"4.4.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Nerve injury related to total knee arthroplasty (TKA) is a rare but serious complication. Previous studies identifying risk factors for nerve injury related to TKA have been constrained by institutional data or small cohorts. The current study utilized a comprehensive, national, administrative database to investigate independent risk factors for nerve injury associated with TKA.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and Methods<\/jats:title>\n<jats:p>The PearlDiver M161 database was queried for adult TKA procedures performed between 2010 and 2022. Cases with postoperative nerve injury within 90 days of surgery were identified. Factors such as patient age, sex, body mass index (BMI), Elixhauser Comorbidity Index (ECI), fracture indication, and type of surgery (primary vs. revision) were evaluated for their correlation with nerve injury using multivariate analyses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Out of 1,517,637 TKA procedures, nerve injury was identified for 4,480 (0.3%). Multivariate analysis identified the following independent risk factors for nerve injury, listed in decreasing order of odds ratio (OR): revision surgery (OR: 1.68), female sex (OR: 1.31), ECI\u2009\u2265\u20095 (OR: 1.27), and younger age (OR: 1.02 per decreasing decade) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05 for each). Factors not significantly associated with nerve injury included underweight BMI (&lt;20\u2009kg\/m<jats:sup>2<\/jats:sup>) and fracture indication. A decreased risk of nerve injury was observed in individuals with a BMI\u2009\u2265\u200935\u2009kg\/m<jats:sup>2<\/jats:sup> (OR: 0.80, <jats:italic>P<\/jats:italic>\u2009=\u20090.002).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>As expected, the incidence of nerve injury following TKA was low at 0.3%. Independent risk factors were identified for this adverse outcome, with the highest risk associated with revision surgeries. These findings, drawn from the largest cohort studied to date, offer valuable insights for risk stratification, and should inform patient discussions.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0324527","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T17:28:26Z","timestamp":1748885306000},"page":"e0324527","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Risk factors for perioperative nerve injury associated with total knee arthroplasty: Analysis of a national administrative database"],"prefix":"10.1371","volume":"20","author":[{"given":"Rahul H.","family":"Jayaram","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2682-3980","authenticated-orcid":true,"given":"Lucas","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6451-8752","authenticated-orcid":true,"given":"Wesley","family":"Day","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rushabh H.","family":"Doshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee E.","family":"Rubin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2626-7278","authenticated-orcid":true,"given":"Jonathan N.","family":"Grauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,6,2]]},"reference":[{"issue":"1","key":"pone.0324527.ref001","article-title":"The primary total knee arthroplasty: a global analysis","volume":"15","author":"J Gao","year":"2020","journal-title":"J Orthop Surg Res"},{"issue":"2","key":"pone.0324527.ref002","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s11420-017-9558-4","article-title":"Total Knee Arthroplasty for Knee Osteoarthritis: Support for a Foregone Conclusion?","volume":"13","author":"ME Steinhaus","year":"2017","journal-title":"HSS J"},{"issue":"17","key":"pone.0324527.ref003","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.2106\/JBJS.17.01617","article-title":"Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030","volume":"100","author":"M Sloan","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"pone.0324527.ref004","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/s11420-018-9614-8","article-title":"Patient satisfaction after total knee replacement: a systematic review","volume":"14","author":"CA Kahlenberg","year":"2018","journal-title":"HSS J"},{"issue":"9","key":"pone.0324527.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0239239","article-title":"Incidence, predictors, and timing of post-operative stroke following elective total hip arthroplasty and total knee arthroplasty","volume":"15","author":"MS Haynes","year":"2020","journal-title":"PLoS One"},{"issue":"1","key":"pone.0324527.ref006","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5792\/ksrr.2016.28.1.1","article-title":"Patient satisfaction after total knee arthroplasty","volume":"28","author":"YJ Choi","year":"2016","journal-title":"Knee Surg Relat Res"},{"issue":"6","key":"pone.0324527.ref007","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1016\/j.arth.2017.01.043","article-title":"Comparison of outpatient vs inpatient total knee arthroplasty: an ACS-NSQIP analysis","volume":"32","author":"P Bovonratwet","year":"2017","journal-title":"J Arthroplasty"},{"issue":"3","key":"pone.0324527.ref008","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.arth.2010.03.020","article-title":"Peroneal nerve dysfunction after total knee arthroplasty: characterization and treatment","volume":"26","author":"MG Zywiel","year":"2011","journal-title":"J Arthroplasty"},{"issue":"2","key":"pone.0324527.ref009","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.ocl.2021.11.002","article-title":"Nerve Injuries in Total Knee Arthroplasty","volume":"53","author":"D Cohen","year":"2022","journal-title":"Orthop Clin North Am"},{"issue":"05","key":"pone.0324527.ref010","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1055\/a-0915-9272","article-title":"Iatrogene nervenl\u00e4sionen in der h\u00fcft- und knieendoprothetik","volume":"158","author":"CL Weynandt","year":"2020","journal-title":"Z Orthop Unfall"},{"issue":"2","key":"pone.0324527.ref011","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1097\/ALN.0b013e3182039f5d","article-title":"Perioperative nerve injury after total knee arthroplasty: regional anesthesia risk during a 20-year cohort study","volume":"114","author":"AK Jacob","year":"2011","journal-title":"Anesthesiology"},{"issue":"10","key":"pone.0324527.ref012","doi-asserted-by":"crossref","first-page":"2473","DOI":"10.1016\/j.arth.2019.05.008","article-title":"Incidence and risk factors for peripheral nerve injury after 383000 total knee arthroplasties using a New York state database (SPARCS)","volume":"34","author":"AB Christ","year":"2019","journal-title":"J Arthroplasty"},{"issue":"4","key":"pone.0324527.ref013","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.arth.2023.10.030","article-title":"Risk Factors for Peripheral Nerve Injury Following Revision Total Knee Arthroplasty in 132,960 Patients","volume":"39","author":"XT Chen","year":"2023","journal-title":"The Journal of Arthroplasty"},{"key":"pone.0324527.ref014","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.arth.2007.05.003","article-title":"Medical malpractice in hip and knee arthroplasty","volume":"22","author":"A Upadhyay","year":"2007","journal-title":"J Arthroplasty"},{"key":"pone.0324527.ref015","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1097\/00003086-199012000-00026","article-title":"Peroneal nerve palsy after total knee arthroplasty","volume":"261","author":"L Asp","year":"1990","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"pone.0324527.ref016","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1002\/mus.26045","article-title":"Risk factors for acute nerve injury after total knee arthroplasty","volume":"57","author":"T Shetty","year":"2018","journal-title":"Muscle Nerve"},{"issue":"9","key":"pone.0324527.ref017","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1016\/j.arth.2013.02.025","article-title":"Common peroneal nerve palsy following total knee arthroplasty: prognostic factors and course of recovery","volume":"28","author":"J Park","year":"2013","journal-title":"J Arthroplasty"},{"key":"pone.0324527.ref018","article-title":"Total Hip Arthroplasty in Patients Who Have Marfan Syndrome: Adverse Events and 5-Year Revision Rates","volume":"39","author":"W Day","year":"2024","journal-title":"J Arthroplasty"},{"issue":"11","key":"pone.0324527.ref019","doi-asserted-by":"crossref","first-page":"2259","DOI":"10.1016\/j.arth.2023.05.072","article-title":"Total Knee Arthroplasty: Variables Affecting 90-day Overall Reimbursement","volume":"38","author":"SJ Halperin","year":"2023","journal-title":"J Arthroplasty"},{"key":"pone.0324527.ref020","first-page":"100115","article-title":"Four-level anterior versus posterior cervical fusions: Perioperative outcomes and five-year reoperation rates: Outcomes after four-level anterior versus posterior cervical procedures","volume":"10","author":"PY Joo","year":"2022","journal-title":"N Am Spine Soc J"},{"issue":"8","key":"pone.0324527.ref021","first-page":"1234","article-title":"Medicaid insurance is associated with more complications and emergency department visits but equivalent 5-year secondary surgery rate after primary hip arthroscopy","volume":"39","author":"SM Gillinov","year":"2023","journal-title":"Arthroscopy"},{"issue":"10","key":"pone.0324527.ref022","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1016\/j.spinee.2023.06.002","article-title":"Weight loss makes the difference: perioperative outcomes following posterior lumbar fusion in patients with and without weight loss following bariatric surgery","volume":"23","author":"M Dhodapkar","year":"2023","journal-title":"Spine J"},{"issue":"11","key":"pone.0324527.ref023","doi-asserted-by":"crossref","DOI":"10.5435\/JAAOSGlobal-D-23-00054","article-title":"Emergency department visits following patellofemoral arthroplasty","volume":"7","author":"PP Ratnasamy","year":"2023","journal-title":"JAAOS Glob Res Rev"},{"key":"pone.0324527.ref024","article-title":"Single-level anterior cervical discectomy and fusion has lower five-year revisions than posterior cervical foraminotomy in a large national cohort","author":"R Jayaram","year":"2023","journal-title":"Spine"},{"issue":"12","key":"pone.0324527.ref025","doi-asserted-by":"crossref","DOI":"10.5435\/JAAOSGlobal-D-23-00226","article-title":"Trends in and factors associated with surgical management for closed clavicle fractures","volume":"7","author":"MM Dhodapkar","year":"2023","journal-title":"JAAOS Glob Res Rev"},{"issue":"12","key":"pone.0324527.ref026","first-page":"1","article-title":"Total hip arthroplasty imageless navigation does not reduce 90-day adverse events or five-year revisions in a large national cohort","volume":"37","author":"RH Jayaram","year":"2022","journal-title":"J Arthroplasty"},{"issue":"12","key":"pone.0324527.ref027","article-title":"Patients With Down Syndrome and Total Hip and Total Knee Arthroplasty: Outcome Measures Show Increased Risk of Perioperative Complications","volume":"7","author":"SJ Halperin","year":"2023","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"issue":"1","key":"pone.0324527.ref028","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.arth.2017.08.032","article-title":"Discriminative Ability of Elixhauser\u2019s Comorbidity Measure is Superior to Other Comorbidity Scores for Inpatient Adverse Outcomes After Total Hip Arthroplasty","volume":"33","author":"NT Ondeck","year":"2018","journal-title":"J Arthroplasty"},{"issue":"8","key":"pone.0324527.ref029","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1054\/arth.2001.26591","article-title":"Nerve injury after primary total knee arthroplasty","volume":"16","author":"MF Schinsky","year":"2001","journal-title":"J Arthroplasty"},{"issue":"4","key":"pone.0324527.ref030","doi-asserted-by":"crossref","DOI":"10.3928\/01477447-20130327-33","article-title":"Surgical decompression improves symptoms of late peroneal nerve dysfunction after TKA","volume":"36","author":"J Ward","year":"2013","journal-title":"Orthopedics"},{"issue":"3","key":"pone.0324527.ref031","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1213\/01.ane.0000194875.05587.7e","article-title":"Anesthetic, patient, and surgical risk factors for neurologic complications after prolonged total tourniquet time during total knee arthroplasty","volume":"102","author":"TT Horlocker","year":"2006","journal-title":"Anesth Analg"},{"issue":"3","key":"pone.0324527.ref032","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/ALN.0b013e3181af61cb","article-title":"Perioperative peripheral nerve injuries","volume":"111","author":"MB Welch","year":"2009","journal-title":"Anesthesiology"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324527","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T17:28:32Z","timestamp":1748885312000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324527"}},"subtitle":[],"editor":[{"given":"Osama","family":"Farouk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,6,2]]},"references-count":32,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0324527","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,2]]}}}