Total Joint Arthroplasty in Ehlers-Danlos Syndrome Is Associated with Increased Instability and Revision: A Systematic Review and Meta-analysis
Abstract
Background: Total joint arthroplasty (TJA) has been increasingly performed in younger and medically complex patients. Ehlers-Danlos syndrome (EDS), a heritable connective tissue disorder characterised by ligamentous laxity and soft tissue fragility, may predispose patients to adverse arthroplasty outcomes, yet existing evidence remains fragmented.
Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Comparative studies evaluating postoperative outcomes following primary TJA in patients with EDS versus non-EDS controls were identified from MEDLINE, Embase, Web of Science, and CENTRAL through November 2025. Random-effects meta-analyses were performed to estimate pooled risk ratios (RRs) for revision, instability or dislocation, aseptic loosening, periprosthetic fracture (PPFx), periprosthetic joint infection (PJI), wound complications, medical complications, and readmission or reoperation.
Results: Nine retrospective cohort studies encompassing over 415,000 patients were included. Compared with non-EDS patients, those with EDS demonstrated a significantly higher risk of instability or dislocation (RR 2.93, 95% CI 2.37-3.61) and all-cause revision (RR 1.97, 95% CI 1.29-3.02), particularly following total hip arthroplasty. Aseptic loosening and wound complications occurred more frequently in EDS patients, though associations were less consistent across models. No significant differences were observed in risks of PJI, medical…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 415,000 participants or records.
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