Preoperative thrombocytopenia is associated with increased total joint arthroplasty postoperative complications

Victor Shen; Rohith Pydi; David Tan; Aribah Shah; Robert Sterling; Jordan Villa Martinez

doi:10.1016/j.jor.2026.03.026

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76 (); 127-132

doi:

10.1016/j.jor.2026.03.026

Preoperative thrombocytopenia is associated with increased total joint arthroplasty postoperative complications

Victor Shen, Rohith Pydi, David Tan, Aribah Shah, Robert Sterling, Jordan Villa Martinez

George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA

⁎Corresponding author: Jordan Villa Martinez. jvilla@mfa.gwu.edu

Received: 2026-2-18, Accepted: 2026-3-18, Published: 2026-3-19

Professor P K Surendran Memorial Education Foundation

Disclaimer:
This article was originally published by Reed Elsevier India Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Preoperative thrombocytopenia has been linked to bleeding and infectious complications, but its short- and midterm impact on outcomes following total joint arthroplasty (TJA) remains unclear.

This study evaluates whether preoperative thrombocytopenia is independently associated with increased postoperative complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Using the TriNetX Research Network, we identified patients who underwent primary TKA or THA between 2010 and 2024 with a documented platelet count within one month prior to surgery and at least one year of follow-up. Two cohorts were formed: those with normal platelet counts (140,000–417,000/μL) and those with thrombocytopenia (<140,000/μL). Propensity-score matching (1:1) was performed and controlled for hemoglobin levels. Complications were assessed at 90-days and 1-year postoperatively.

A total of 11,985 matched patients were included (6627 TKA; 5358 THA). In the TKA cohort, thrombocytopenia was associated with higher odds of: surgical site infection (SSI) [OR: 1.46 (1.14, 1,87), P = 0.002], acute kidney injury (AKI) [OR: 1.54 (1.23, 1.89), P < 0.0001], transfusion [OR: 1.87 (1.55, 2.25), P < 0.0001), deep vein thrombosis (DVT) [OR: 1.52 (1.15, 2.01), P = 0.003], heart failure [OR: 1.27 (1.09, 1.49), P = 0.002), and 1-year periprosthetic joint infection (PJI) [OR: 1.60 (1.389, 1.98), P < 0.0001]. In the THA cohort, thrombocytopenia was associated with increased odds of SSI [OR: 1.43 (1.11, 1.84), P = 0.006], AKI [OR: 1.46 (1.19, 1.78), P < 0.0001], transfusion [OR: 1.95 (1.66, 2.28), P < 0.0001], myocardial infarction (OR: 1.45 (1.02, 2.07), P = 0.040], arrhythmia [OR 1.13 (1.01, 1.27), P = 0.029], and 1-year PJI [OR 1.42 (1.13, 1.77), P = 0.002].

Preoperative thrombocytopenia is independently associated with increased postoperative complications in TKA and THA. These findings support incorporating platelet count into preoperative risk stratification and warrant further investigation into targeted management strategies.

1 Introduction

Total joint arthroplasty (TJA), encompassing total hip (THA) and total knee arthroplasty (TKA), is among the most commonly performed orthopedic procedures, with an expected rise in demands the coming decades.¹ While TJA reliably improves function and quality of life, it carries risk for serious postoperative complications, including periprosthetic joint infection (PJI), a leading cause of early revision surgery and morbidity.² Identifying modifiable patient-specific risk factors remains critical to improving outcomes and reducing healthcare costs.

Preoperative complete blood counts (CBCs) are routinely performed to evaluate hematological abnormalities that may increase complications after TJA.³ Preoperative anemia has been consistently found to increase postoperative complications in patients undergoing TJA.⁴ However, the impact of low preoperative platelet count, or thrombocytopenia, on postoperative outcomes in the general TJA population is less clear. Bujnowski et al. in their single center retrospective study reports preoperative thrombocytopenia (platelet count <150,000) in up to 7.3% for THA and 8.3% for TKA patients.⁵ Studies investigating the impact of preoperative thrombocytopenia on TJA have been limited by small sample size or short follow-up periods.^5–7

Given the limited literature on preoperative thrombocytopenia in the context of TJA, it is crucial to elucidate its postoperative complications. Platelets serve essential functions in hemostasis, wound repair, inflammatory responses, and thrombus formation.⁸ We hypothesized that preoperative thrombocytopenia independently increases risks of short and mid-term complications after TJA. The purpose of this study was to evaluate whether preoperative thrombocytopenia was associated with increased 90-day complications and 1-year PJI in patients undergoing primary THA or TKA.

2 Methods

2.1

2.1 Study population

We performed a retrospective cohort study using the TriNetX Research Network, a multicenter federated database of de-identified electronic medical records.10 Due to the publicly available and de-identified nature of the database, this study is exempt from Institutional Board Review and approval. The query was executed on June 14, 2025, to identify patients who underwent TKA and THA with a documented preoperative platelet count within one month of surgery and at least one year of postoperative follow-up. Patients were identified using a combination of Current Procedural Terminology (CPT) codes 27130 and 27447, as well as International Classification of Diseases, Ninth and Tenth Revision (ICD-9/10) procedure codes, including 81.51 and 81.54. Within their subsequent THA and TKA groupings, patients were divided into two cohorts: 1) an experimental group consisting of thrombocytopenic patients (platelet count <140,000/μL) and 2) a control group with platelet counts within the normal range (140,000–417,000/μL), consistent with thresholds used in prior studies by Malpani et al. and Telang et al.⁷^,⁹ Platelet counts were identified by the following formula in TriNetX: “Platelets [#/volume] in Blood”. Any patient with a diagnosis of malignant neoplasms of lymphoid, hematopoietic, or related tissue (ICD-10-CM C81–C96), as well as those with a prior history of chemotherapy (based on TriNetX-curated variables), were excluded from all cohorts.

2.2

2.2 Demographic, comorbidities, and outcome measures

Because thrombocytopenia may be associated with demographic variations and other clinical comorbidities, 1:1 propensity matching was critical to minimize confounding variables.¹⁰ Thrombocytopenic cohorts were 1:1 propensity matched to their respective control cohorts based on age, sex, ethnicity, BMI, atrial fibrillation and flutter, diabetes mellitus, heart failure, chronic ischemic heart disease, essential hypertension, hyperlipidemia, chronic kidney disease (CKD), obstructive pulmonary disease, liver disease, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), immune thrombocytopenic purpura (ITP), and most recent preoperative hemoglobin value.

Following propensity-score matching, statistical analysis was conducted within the TriNetX platform to compare rates of postoperative complications between the thrombocytopenic and control cohorts. Our outcomes of interest were identified using ICD-9/10 codes, with a complete list provided in Appendix A. Complications within the 90-day global surgery period included superficial infection, deep infection, surgical site infection (SSI), urinary tract infection (UTI), acute kidney injury (AKI), transfusion, myocardial infarction (MI), pulmonary embolism (PE), deep vein thrombosis (DVT), pneumonia, stroke, heart failure, arrhythmia, and all-cause mortality. Surgical site infection included both superficial skin infections and deep infections such as PJI. Risk of PJI within 1 year of surgery was further assessed. Patient demographics and rates of complications were evaluated using Chi-squared tests, student's t-test, and Mann-Whitney U when appropriate. Number of events and odds ratios (OR) with 95% confidence intervals (CI) were reported. Statistical significance was defined as P < 0.05.

3 Results

3.1

3.1 Total knee arthroplasty outcomes

A total of 6627 thrombocytopenic patients who underwent TKA were matched with 6627 control patients. The average age, BMI, and hemoglobin of patients after matching were 67.5 ± 8.7 years, 32.1 ± 6.3 kg/m², and 13.5 ± 1.8 g/dL, respectively (See Table 1).

Table 1 Demographics and Clinical Comorbidities Before and After Matching for the Total Knee Arthroplasty Cohort. Low platelet count defined as <140,000/μL and normal platelet count defined as 140,000–417,000/μL. aOR = adjusted odds ratio; DM = diabetes mellitus; AFib = atrial fibrillation and flutter; HTN = essential (primary) hypertension; HLD = hyperlipidemia, unspecified; CKD = chronic kidney disease; COPD = other chronic obstructive pulmonary disease; RA = rheumatoid arthritis; SLE = systemic lupus erythematosus; ITP = immune thrombocytopenic purpura.

Total Knee Arthroplasty
	Before matching					After matching
	Low Platelet		Normal Platelet		P-value	Low Platelet		Normal Platelet		P-value
	N	%	N	%		N	%	N	%
Total	6706		183,059			6627		6627
Age at Index	67.5 ± 8.7	-	65.6 ± 9.1	-	<0.001	67.5 ± 8.7		67.5 ± 8.7		0.711
BMI	32.1 ± 6.3	-	32.5 ± 6.4	-	<0.001	32.1 ± 6.3		32.4 ± 6.1		0.07
Hemoglobin [Mass/volume] in Blood	13.5 ± 1.8	-	13.7 ± 1.5	-	<0.001	13.5 ± 1.8		13.8 ± 1.5		<0.001
Female	2527	37.9	107,018	58.8	<0.001	2513	37.9	2396	36.2	0.035
Black or African American	739	11.1	21,062	11.6	0.214	735	11.1	744	11.2	0.804
Male	3901	58.5	67,633	37.2	<0.001	3875	58.5	3969	59.9	0.097
White	4870	73	135,435	74.4	0.009	4839	73	4818	72.7	0.682
Hispanic or Latino	371	5.6	8423	4.6	<0.001	366	5.5	357	5.4	0.731
Other Race	128	1.9	3133	1.7	0.225	126	1.9	120	1.8	0.699
Asian	396	5.9	8103	4.5	<0.001	395	6	376	5.7	0.481
Clinical Comorbidities
DM	1987	29.8	38,109	20.9	<0.001	1966	29.7	1989	30	0.662
AFib	919	13.8	13,179	7.2	<0.001	913	13.8	892	13.5	0.595
Heart failure	743	11.1	9363	5.1	<0.001	737	11.1	711	10.7	0.469
Chronic ischemic heart disease	1590	23.8	25,042	13.8	<0.001	1576	23.8	1567	23.6	0.854
HTN	4207	63.1	106,939	58.8	<0.001	4172	63	4165	62.8	0.9
HLD	2902	43.5	73,336	40.3	<0.001	2876	43.4	2900	43.8	0.674
CKD	965	14.5	14,377	7.9	<0.001	955	14.4	895	13.5	0.133
COPD	571	8.6	10,962	6	<0.001	564	8.5	553	8.3	0.731
Diseases of liver	1352	20.3	13,608	7.5	<0.001	1339	20.2	1325	20	0.762
RA with rheumatoid factor	44	0.7	999	0.5	0.231	43	0.6	30	0.5	0.127
Other RA	219	3.3	5753	3.2	0.577	217	3.3	192	2.9	0.209
SLE	57	0.9	1066	0.6	0.005	57	0.9	51	0.8	0.562
ITP	161	2.4	142	0.1	<0.001	119	1.8	104	1.6	0.311

Thrombocytopenic patients who underwent TKA were associated with significantly increased odds of 90-day SSI [aOR: 1.461, 95% CI 1.141-1.869, P = 0.002), AKI (aOR: 1.538, 95% CI 1.255-1.886, P < 0.0001), transfusion (aOR: 1.87, 95% CI 1.553-2.251, P < 0.0001), DVT (aOR: 1.522, 95% CI 1.153-2.009, P = 0.003), heart failure (aOR: 1.271, 95% CI 1.088-1.485, P = 0.002), and 1-year PJI (aOR: 1.596, 95% CI 1.285-1.983, P < 0.0001). No significant differences were observed between thrombocytopenic patients and control patients for odds of 90-day superficial infection, deep infection, UTI, MI, PE, pneumonia, stroke, arrythmia, or all-cause mortality (See Table 2).

Table 2 Postoperative Complications in Total Knee Arthroplasty Stratified by Preoperative Platelet Count. Low platelet count defined as <140,000/μL and normal platelet count defined as 140,000–417,000/μL. aOR = adjusted odds ratio; SSI = surgical site infection; UTI = urinary tract infection; AKI = acute kidney injury; MI = myocardial infarction; PE = pulmonary embolism; DVT = deep vein thrombosis; PJI = periprosthetic joint infection.

Total Knee Arthroplasty
N = 6627 patients	Low PlateletN (%)	Normal PlateletN (%)	aOR	95% CI	P-Value
Superficial Infection	22 (0.3)	22 (0.3)	1.000	(0.553, 1.808)	1.000
Deep Infection	10 (0.2)	10 (0.2)	1.000	(0.416, 2.404)	1.000
SSI	158 (2.4)	109 (1.6)	1.461	(1.141, 1.869)	0.002
UTI	200 (3)	177 (2.7)	1.134	(0.924, 1.392)	0.229
AKI	240 (3.6)	158 (2.4)	1.538	(1.255, 1.886)	< 0.0001
Transfusion	327 (4.9)	179 (2.7)	1.870	(1.553, 2.251)	< 0.0001
MI	38 (0.6)	36 (0.5)	1.056	(0.668, 1.668)	0.816
PE	72 (1.1)	67 (1)	1.075	(0.770, 1.503)	0.670
DVT	127 (1.9)	84 (1.3)	1.522	(1.153, 2.009)	0.003
Pneumonia	72 (1.1)	64 (1)	1.126	(0.803, 1.580)	0.490
All-cause mortality	21 (0.3)	21 (0.3)	1.000	(0.546, 1.833)	1.000
Stroke	58 (0.9)	50 (0.8)	1.161	(0.794, 1.698)	0.440
Heart Failure	378 (5.7)	301 (4.5)	1.271	(1.088, 1.485)	0.002
Arrhythmia	821 (12.4)	753 (11.4)	1.103	(0.993, 1.226)	0.068
1-yr PJI	216 (3.3)	137 (2.1)	1.596	(1.285, 1.983)	< 0.0001

3.2

3.2 Total hip arthroplasty outcomes

A total of 5358 thrombocytopenic patients who underwent THA were matched with 5358 control patients. The average age, BMI, and hemoglobin of patients after matching were 65.0 ± 11.2 years, 29.4 ± 6.1 kg/m², and 13.5 ± 1.8 g/dL, respectively (See Table 3).

Table 3 Demographics and Clinical Comorbidities Before and After Matching for the Total Hip Arthroplasty Cohort. Low platelet count defined as <140,000/μL and normal platelet count defined as 140,000–417,000/μL. aOR = adjusted odds ratio; DM = diabetes mellitus; AFib = atrial fibrillation and flutter; HTN = essential (primary) hypertension; HLD = hyperlipidemia, unspecified; CKD = chronic kidney disease; COPD = other chronic obstructive pulmonary disease; RA = rheumatoid arthritis; SLE = systemic lupus erythematosus; ITP = immune thrombocytopenic purpura.

Total Hip Arthroplasty
	Before matching					After matching
	Low Platelet		Normal Platelet		P-value	Low Platelet		Normal Platelet		P-value
	N	%	N	%		N	%	N	%
Total	5440		131,116	-	-	5358		5358	-	-
Age at Index	65.0 ± 11.2	-	63.5 ± 10.9	-	<0.001	65.0 ± 11.2	-	65.3 ± 10.9	-	0.143
BMI	29.4 ± 6.1	-	30.1 ± 6.1	-	<0.001	29.4 ± 6.1	-	30.2 ± 6.2	-	<0.001
Hemoglobin [Mass/volume] in Blood	13.2 ± 2.1	-	13.7 ± 1.5	-	<0.001	13.2 ± 2.1	-	13.6 ± 1.8	-	<0.001
Female	1900	35.3	67,628	51.9	<0.001	1891	35.3	1879	35.1	0.808
Black or African American	584	10.8	13,188	10.1	0.086	582	10.9	586	10.9	0.901
Male	3273	60.8	56,468	43.3	<0.001	3255	60.8	3291	61.4	0.476
White	4149	77	102,175	78.4	0.015	4126	77	4177	78	0.238
Hispanic or Latino	176	3.3	3466	2.7	0.007	175	3.3	153	2.9	0.217
Other Race	71	1.3	1419	1.1	0.114	70	1.3	54	1	0.148
Asian	189	3.5	3298	2.5	<0.001	189	3.5	180	3.4	0.634
Clinical Comorbidities
DM	1167	21.7	20,130	15.5	<0.001	1156	21.6	1161	21.7	0.907
AFib	772	14.3	9226	7.1	<0.001	764	14.3	829	15.5	0.078
Heart failure	594	11	6471	5	<0.001	588	11	614	11.5	0.426
Chronic ischemic heart disease	1209	22.4	16,653	12.8	<0.001	1198	22.4	1231	23	0.446
HTN	3205	59.5	68,017	52.2	<0.001	3183	59.4	3217	60	0.503
HLD	2125	39.5	47,729	36.6	<0.001	2103	39.2	2170	40.5	0.186
CKD	826	15.3	9404	7.2	<0.001	816	15.2	815	15.2	0.979
COPD	565	10.5	8753	6.7	<0.001	561	10.5	545	10.2	0.611
Diseases of liver	1048	19.5	8913	6.8	<0.001	1034	19.3	1049	19.6	0.714
RA with rheumatoid factor	31	0.6	614	0.5	0.276	31	0.6	30	0.6	0.898
Other RA	187	3.5	3471	2.7	<0.001	186	3.5	194	3.6	0.676
SLE	77	1.4	868	0.7	<0.001	76	1.4	66	1.2	0.398
ITP	127	2.4	139	0.1	<0.001	99	1.8	79	1.5	0.131

Thrombocytopenic patients who underwent THA were associated with significantly increased odds of 90-day SSI (aOR: 1.425, 95% CI 1.105-1.837, P = 0.006), AKI (aOR: 1.456, 95% CI 1.193-1.778, P < 0.0001), transfusion (aOR: 1.946, 95% CI 1.662-2.277, P < 0.0001), MI (aOR: 1.449, 95% CI 1.015-2.067, P = 0.04), arrythmia (aOR: 1.134, 95% CI 1.013-1.269, P = 0.029), and 1-year PJI (aOR: 1.416, 95% CI 1.134-1.769, P = 0.002). No significant differences were observed between thrombocytopenic patients and control patients for odds of 90-day superficial infection, deep infection, UTI, PE, DVT, pneumonia, stroke, heart failure, or all-cause mortality (See Table 4).

Table 4 Postoperative Complications in Total Hip Arthroplasty Stratified by Preoperative Platelet Count. Low platelet count defined as <140,000/μL and normal platelet count defined as 140,000–417,000/μL. aOR = adjusted odds ratio; SSI = surgical site infection; UTI = urinary tract infection; AKI = acute kidney injury; MI = myocardial infarction; PE = pulmonary embolism; DVT = deep vein thrombosis; PJI = periprosthetic joint infection.

Total Hip Arthroplasty
N = 5358 patients	Low PlateletN (%)	Normal PlateletN (%)	aOR	95% CI	P-Value
Superficial Infection	16 (0.3)	19 (0.4)	0.842	(0.432, 1.638)	0.612
Deep Infection	10 (0.2)	10 (0.2)	1.000	(0.416, 2.405)	1.000
SSI	147 (2.7)	104 (1.9)	1.425	(1.105, 1.837)	0.006
UTI	184 (3.4)	158 (2.9)	1.170	(0.943, 1.453)	0.153
AKI	244 (4.6)	170 (3.2)	1.456	(1.193, 1.778)	< 0.0001
Transfusion	473 (8.8)	254 (4.7)	1.946	(1.662, 2.277)	< 0.0001
MI	75 (1.4)	52 (1)	1.449	(1.015, 2.067)	0.040
PE	56 (1)	54 (1)	1.037	(0.712, 1.511)	0.848
DVT	73 (1.4)	59 (1.1)	1.241	(0.878, 1.752)	0.220
Pneumonia	95 (1.8)	78 (1.5)	1.222	(0.903, 1.653)	0.193
Death	17 (0.3)	11 (0.2)	1.547	(0.724, 3.306)	0.256
Stroke	55 (1)	39 (0.7)	1.415	(0.937, 2.136)	0.097
Heart Failure	331 (6.2)	310 (5.8)	1.072	(0.914, 1.258)	0.392
Arrhythmia	734 (13.7)	658 (12.3)	1.134	(1.013, 1.269)	0.029
1-yr PJI	192 (3.6)	137 (2.6)	1.416	(1.134, 1.769)	0.002

4 Discussion

The findings of our study align with and expand upon prior literature evaluating the association between thrombocytopenia and postoperative complications.⁶^,⁷ Malpani et al. identified increased postoperative medical complications at 30 days in patients undergoing TKA with platelet counts <116,000 (n = 1594) or > 492,000 μL using a relative risk threshold of >1.5 to define clinical significance.⁶ In another study, Malpani et al. also identified increased postoperative complications at 30 days in patients undergoing elective posterior lumbar surgery but with platelet counts <140,000 or >447,000/μL.⁹ Telang et al. found that morbidly obese patients with preoperative platelets <140,000 μL (n < 300, was not specified) undergoing TKA had an increased risk of PJI at 90-days.⁷ Similarly, in a study by Chung et al., TKA patients with preoperative platelet counts <150,000/μL (n = 10,866), while accounting for INR, PTT, and documented bleeding disorders, also had an elevated risk of 30-day deep SSIs. However, low preoperative platelet counts alone did not account for increased deep SSI in THA.⁵

Our study expanded the analysis of postoperative medical complications to 90-day and 1-year outcomes in a larger cohort. Our 90-day complication results in the TKA group with preoperative thrombocytopenia align with Malpani et al.’s 30-day TKA findings, which showed thrombocytopenic patients having increased risks of SSI, AKI, blood transfusions, DVT, and heart failure.⁵ While Malpani et al. did not investigate THA outcomes, we found that patients undergoing THA also presented with increased rates of 90-day medical complications, including SSI, AKI, blood transfusions, MI, and arrhythmias. We hypothesize that the increased cardiac complications in the THA cohort may reflect the greater intraoperative blood loss and physiological stress typically associated with THA.¹¹ We also report increased 1-year risk of PJI in both TKA and THA cohorts with preoperative thrombocytopenia. Although Chung et al. did not observe this association in THA, the study by Telang et al. align with our results and showed elevated risk of PJI in both TKA and THA cohorts at 90-days.⁵^,⁷

The mechanisms underlying these associations are likely multifactorial. Platelets play an essential role in hemostasis and are recognized for their involvement in immune modulation and tissue repair.¹² Low platelet counts can impair clot formation, increase susceptibility to bleeding, and compromise the body's ability to mount an effective immune response to pathogens introduced during surgery.¹³^,¹⁴ These mechanisms may contribute to the postoperative complications observed in prior literature and in this study, such as the increased risk of surgical site infection and need for blood transfusions. The suboptimal perfusion and hemodynamic status may stress the kidneys and heart, leading to increased rates of AKI, MI, heart failure, and arrhythmias we observed. We are unsure of how thrombocytopenia paradoxically causes increased risk of DVT, given that platelets play a coagulative role. Perhaps thrombocytopenia induces a state of inflammation, causing this observation.

Given that preoperative anemia also increases risk for postoperative complications, it is important to take preoperative hemoglobin into context as well.¹⁵ However, the interplay between platelet counts and other hematologic parameters, such as hemoglobin, remains unclear. Some studies suggest an inverse relationship, while others report concomitant reductions, making it difficult to isolate the mechanisms through which thrombocytopenia contributes to adverse outcomes.¹⁶ To control for this confounder, we used propensity score-matching so that patients have a similar hemoglobin baseline, regardless of whether they were thrombocytopenic or not.

Due to the routine nature of preoperative CBCs, platelet monitoring and optimization may be a valuable addition to the surgery planning process in patients undergoing TJA. However, treatment options for preoperative thrombocytopenia are currently limited. While platelet transfusions are available, they carry risks and lack standardized indications in the TJA population.¹⁷ Desmopressin, a synthetic vasopressin analog, has shown promise in enhancing platelet-mediated hemostasis and improving thrombus formation in vitro. It has been used in cardiothoracic and gastrointestinal surgery to reduce blood loss in patients with significant hemorrhage and may be an area of future research in high-risk TJA patients.^18–21

Our study has several limitations common to using a large database. As a retrospective analysis, it lacks the granularity of manual chart review, which could have confirmed the severity and timing of complications. Additionally, there may be a wide range of platelet counts in patients identified as thrombocytopenic. Platelet values may vary, but we chose to identify thrombocytopenia as a platelet count of <140,000 μL due to the cut off being used in several other studies.⁷^,⁹ Furthermore, thrombocytopenia may not occur in isolation but instead may reflect other underlying causes. To address this, we utilized robust propensity score matching in our study cohorts to account for conditions that cause thrombocytopenia or may have confounded our results, such as immune thrombocytopenic purpura, systematic lupus erythematous, chemotherapy, and hemoglobin values. Nonetheless, our large sample size and long-term follow-up strengthen the reliability of our findings.

5 Conclusion

Preoperative thrombocytopenia is associated with significantly increased risks of short and mid-term complications in the setting of total joint arthroplasty. These findings underscore the importance of including platelet count as part of a comprehensive preoperative risk stratification for patients undergoing TJA. Further research is needed to elucidate management strategies for patients with preoperative thrombocytopenia.

Ethical review committee

This study was exempt from Institutional Board Review due to the publicly available de-identified data.

Consent

Due to the publicly available and de-identified nature of the database, this study is exempt from Institutional Board Review and approval. Parent and guardian consent isn't applicable.

Credit statement

Victor Shen: Conceptualization, Methodology, Data analysis, Draft Preparation. Rohith Pydi: Methodology, Data analysis, Draft Preparation. David Tan: Methodology, Data analysis, Draft Preparation. Aribah Shah: Draft Editing. Robert Sterling: Draft Editing. Jordan Villa Martinez: Writing- Reviewing and Editing.<a name = "Line_supportingmanuscript1_1">

Ethical statement

Due to the publicly available and de-identified nature of the database, this study is exempt from Institutional Board Review and approval. We have no ethical statements to disclose.

Funding statement

We have no funding to disclose.

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