The risk of postoperative complications may be greater in patients with Down syndrome and osteoarthritis who underwent total hip and knee arthroplasty, according to a recent study published by Halperin et al in the Journal of the American Academy of Orthopaedic Surgeons. Investigators used the 2010 to 2021 Q1 PearlDiver M151 database to identify 304 patients with Down syndrome and 3,027 patients without Down syndrome who underwent total hip or knee arthroplasty. Patients with Down syndrome were more likely to experience postoperative complications such as adverse events, sepsis, minor adverse events, urinary tract infections, acute kidney injuries, and pneumonia within 90 days of the procedures. After a follow-up of 2 years, they reported no statistically significant differences in the revision rates between those with and without Down syndrome. The investigators hope their new findings can inform physicians when considering perioperative risks, counseling, and care pathways in this patient population.