Clinical Outcome of Total Knee Arthroplasty After Prior Microfracture: A Matched Cohort Study

Abstract

Microfracture (MFX) is a common operation for articular cartilage lesions. Data for patients who underwent total knee arthroplasty (TKA) after previous MFX are limited. The purpose of this study was to determine the outcomes, complications, and factors that influence outcomes in patients with previous MFX compared with those without previous MFX. Between 2005 and 2014, twenty-one TKAs were performed at a single tertiary care academic institution in patients with prior history of MFX surgery. These patients were retrospectively reviewed and matched 2:1 to patients who did not undergo previous MFX (n=42). Knee Society Score (KSS) (Subjective [KSS-S] and Function [KSS-F]) and complications were documented. Mean KSS-S in the MFX group increased significantly less (52.9 to 77.6) (P<.01) compared with the control group (51.3 to 83.8) (P<.01). The MFX group also demonstrated significantly less improvement in KSS-F from 63.0 to 88.9 (P=.02), whereas the control group demonstrated improvement from 52.4 to 87.1 (P=.02). At 5 years, the failure rate was 4.8% in the MFX group and 2.4% in the control group. Multivariate analysis found that older age at TKA resulted in smaller improvement in KSS-S. Paired relationships between increased age and decreased preoperative range of motion and women with an increased body mass index negatively affected KSS-S. Survivorship was similar between groups, but patients with MFX had slightly less clinical improvement compared with a matched control group. This study suggests that underlying patient factors may limit clinical improvement compared with primary TKA. [Orthopedics. 2017; 40(3):e473-e478.].

Previous cartilage surgery is associated with inferior patient‐reported outcomes after knee arthroplasty

“…Significantly lower KOOS Symptoms, Pain, and QoL subscores after knee arthroplasty were demonstrated in the previous cartilage cohort. This concurs with the findings of Ansari et al [11] in a cohort of 21 previous microfracture patients with a mean 7.8 points lower improvement in the Knee Society Score (KSS) in the cartilage cohort than in a matched group of knee arthroplasty patients. The difference in KSS is, however, below the clinically important difference demonstrated by Lizaur‑Utrilla et al [25].…”

“…The difference in KSS is, however, below the clinically important difference demonstrated by Lizaur-Utrilla et al [25]. Ansari et al [11] did not report any power analysis prior to analysing the KSS results and the power analysis of the present study suggests that the Ansari study was underpowered.…”

“…None of the patients included in that analysis had been treated for FCL. Only a few studies [11,12], involving a limited number of patients, have reported patient-reported outcomes after knee arthroplasty in individuals with previous FCL. These studies have several limitations such as only including patients treated with microfracture or the inclusion of patients with concomitant meniscal allografts and thus have limited external validity.…”

Osteoarthritis- a systematic review of long-term safety implications for osteoarthritis of the knee

“…Four studies [40–43] investigated the long-term effect of various interventions and the progression to TKA. In one study, ninety-five patients with moderate to severe OA showed significant improvement in KOOS score post TKA [42].…”

“…However, compared to the control group, the TKA group had a fourfold increase in complications over the 12-month follow-up period. The other studies showed that previous knee surgery including microfracture leads to an increase in progression to a TKA [43] and post-traumatic KOA requiring TKA has a worse outcome than that for non-traumatic OA [41] (Table 1).…”