ArticleInternational orthopaedics2026
Revision and complication rates after total joint arthroplasty in patients with monoclonal gammopathy of undetermined significance and multiple myeloma.
Article in International orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo characterize the complication profiles and implant survivorship of multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS) patients undergoing primary hip and knee total joint arthroplasty (TJA).
methodsA retrospective analysis was conducted of MM and MGUS patients who underwent TJA at our tertiary academic center from 2005-2023. Included patients had a history of MM or MGUS prior to undergoing primary TJA, with a minimum of year post-operative follow-up. The primary outcomes were perioperative or post-operative complications and need for revision surgery. Univariate and multivariate logistic regression assessed post-operative complications, and Fine-Gray competing-risk models evaluated revision and secondary procedures with death as a competing event.
resultsA total of 68 patients (MM: n = 43; MGUS: n = 25) were analyzed with a mean follow-up of 5.16 and 5.35 years, respectively. Overall, 27.9% of patients experienced at least one post-operative complication and 25.0% required revision surgery. Revision risk did not differ significantly between MM and MGUS patients on competing-risk analysis (sHR 1.49, 95% CI 0.57-3.90, P = 0.42). On univariate analysis, avascular necrosis (OR 6.36, P = 0.033) and higher body mass index (BMI) (OR 1.11, P = 0.049) were associated with post-operative complications. After multivariate adjustment, a primary arthroplasty indication of osteoarthritis was independently associated with lower odds of complications (OR 0.06, 95% CI 0.01-0.63, P = 0.019). Competing-risk analysis further demonstrated a higher risk of secondary procedures following TKA versus THA (sHR 3.09, 95% CI 1.11-8.58, P = 0.030).
conclusionPatients with MM and MGUS undergoing TJA experienced substantial complication and revision rates. Although there was no significant difference in revision risk between MM and MGUS, the small sample size and heterogeneity limit direct comparisons. These findings underscore the potentially under recognized relevance of MGUS in arthroplasty and the need for further investigation in larger cohorts.
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