{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T11:31:50Z","timestamp":1786361510088,"version":"build-2736575974"},"reference-count":17,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["RS-2022-KH130747"],"award-info":[{"award-number":["RS-2022-KH130747"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"award":["RS-2022-KH130747"],"award-info":[{"award-number":["RS-2022-KH130747"]}],"id":[{"id":"https:\/\/ror.org\/00fdzyk40","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Thrombocytopenia increases bleeding tendency and may complicate perioperative management in total knee arthroplasty (TKA), yet data on both in-hospital burden and post-discharge adverse events are limited. This study evaluated the association between preoperative platelet count and outcomes after primary TKA. Methods: In total, 3474 primary TKAs performed for osteoarthritis at a single institution (2008\u20132023) were retrospectively reviewed. Patients were classified as Normal, Mild, Moderate, or Severe by preoperative platelet count; the Severe group (N = 6) was excluded from comparative analyses and reported descriptively. Inverse probability of treatment weighting (IPTW) balanced baseline covariates. In-hospital outcomes were red blood cell (RBC) transfusion, intensive care unit (ICU) admission, and length of stay; follow-up outcomes were 30-day readmission, 1-year periprosthetic joint infection (PJI), and 1-year mortality. Results: After IPTW, the RBC transfusion rate rose with lower platelet count (Normal, 14.0%; Mild, 27.0%; Moderate, 32.5%; p &lt; 0.001), and transfusion volume peaked in the Moderate group. ICU admission was more frequent (Moderate, 6.0%; Normal, 0.7%; Mild, 0.4%; p = 0.002), and length of stay increased with severity (p = 0.008). Readmission, 1-year PJI, and mortality were comparable across groups. In multivariable analysis, moderate thrombocytopenia was independently associated with RBC transfusion (adjusted odds ratio [aOR], 3.26; 95% confidence interval [CI], 1.51\u20136.59; p &lt; 0.001) and ICU admission (aOR, 5.46; 95% CI, 1.37\u201317.41; p = 0.008), but not PJI or mortality. Conclusions: Preoperative thrombocytopenia\u2014particularly in the mild-to-moderate range evaluated in this study\u2014increased perioperative burden after TKA, with higher RBC transfusion and ICU utilization, but was not associated with a significant increase in major postoperative adverse events during 1-year follow-up. Even if not causally responsible, a low preoperative platelet count is a routinely available marker that may flag patients requiring closer perioperative attention. As the associated burden appears largely limited to the hospitalization period, such attentive in-hospital management may allow these patients to achieve favorable outcomes.<\/jats:p>","DOI":"10.3390\/jcm15166187","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:23:50Z","timestamp":1786357430000},"page":"6187","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Thrombocytopenia Increases In-Hospital Burden but Not Postoperative Adverse Events After Total Knee Arthroplasty"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6794-3623","authenticated-orcid":false,"given":"Jisu","family":"Park","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moon Jong","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minji","family":"Han","sequence":"additional","affiliation":[{"name":"Big Data Center, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Wee","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2731-749X","authenticated-orcid":false,"given":"Tae Woo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6564-4294","authenticated-orcid":false,"given":"Young-Kyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8597-1054","authenticated-orcid":false,"given":"Chong Bum","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Baik","family":"Kang","sequence":"additional","affiliation":[{"name":"Knee Center, Gangnam St. Peter\u2019s General Hospital, Seoul 07061, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.bja.2018.09.010","article-title":"Perioperative thrombocytopenia: Evidence, evaluation, and emerging therapies","volume":"122","author":"Nagrebetsky","year":"2019","journal-title":"Br. 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Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S177","DOI":"10.1016\/j.arth.2023.01.042","article-title":"Preoperative anemia is an independent risk factor for increased complications and mortalities after total knee arthroplasty regardless of postoperative transfusions","volume":"38","author":"Harris","year":"2023","journal-title":"J. Arthroplast."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Lim, S.-J., Yeo, I., Park, C.-W., Moon, Y.-W., and Park, Y.-S. (2015). Outcomes of total hip arthroplasty in patients with primary immune thrombocytopenia. BMC Musculoskelet. Disord., 16.","DOI":"10.1186\/s12891-015-0742-8"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.arth.2021.08.032","article-title":"Chronic thrombocytopenia and in-hospital outcomes after primary total hip and knee arthroplasty","volume":"37","author":"Wang","year":"2022","journal-title":"J. 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Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e0308","DOI":"10.1097\/MD.0000000000010308","article-title":"Multiple total hip arthroplasties in refractory immune thrombocytopenic purpura: A case report and literature review","volume":"97","author":"Tang","year":"2018","journal-title":"Medicine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1413.e15","DOI":"10.1016\/j.arth.2012.01.012","article-title":"Heparin-induced thrombocytopenia after total knee arthroplasty, with subsequent adrenal hemorrhage","volume":"27","author":"Chow","year":"2012","journal-title":"J. Arthroplast."},{"key":"ref_16","first-page":"469879","article-title":"Total hip arthroplasty for rapidly destructive coxarthrosis in a patient with severe platelet deficiency due to liver cirrhosis and immune thrombocytopenic purpura","volume":"2015","author":"Hama","year":"2015","journal-title":"Case Rep. 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Arthroplast."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6187\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:57:26Z","timestamp":1786359446000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6187"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":17,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166187"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166187","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]}}}