Increased complications rates and inferior patient reported outcomes following total knee arthroplasty due to post‐traumatic osteoarthritis with previous fracture treatment: a systematic review

Abstract

Purpose This study aims to present the existing literature relating to patient-reported outcome measures (PROMs) and complications in patients undergoing total knee arthroplasty (TKA) due to posttraumatic osteoarthritis (PTOA) with prior fracture treatment around the knee compared with patients who underwent TKA because of primary osteoarthritis (OA). Methods A systematic review was undertaken and synthesised in accordance with the PRISMA guidelines by searching existing literature in the following databases: PubMed, Scopus, Cochrane Library and EMBASE. A search string according to the PECO was used. After analysing 2781 studies, 18 studies (5729 PTOA patients/149,843 OA patients) were included for a final review. An analysis revealed that 12 (67%) were retrospective cohort studies, four (22%) were register studies and the remaining two (11%) were prospective cohort studies. The mean Critical Appraisal Skills Programme (CASP) score was 23.6 out of 28, signifying studies of moderate quality. Results The most frequently reported outcome measure were postoperative complications, reported in all eighteen studies. Intraoperative complications were reported in ten (4165 PTOA/124.511 OA) and patient-reported outcome measures (PROMs) in six studies (210 PTOA/2768 OA). A total of nine different PROMs were evaluated. As far as PROMs were concerned, the scores were inferior for PTOA but did not differ statistically from OA, except for one study, which favoured the OA group. Across all studies, postoperative complications were higher in the PTOA group, reporting infections as the most common complication. Furthermore, a higher revision rate was reported in the PTOA group. Conclusion PROM analysis suggests that both patient groups benefit from a TKA in terms of functional outcome and pain relief, however, patient-reported outcomes could be inferior for PTOA patients. There is consistent evidence for increased complication rates following PTOA TKA. Patients undergoing TKA due to PTOA after fracture treatment should be informed about the risk for inferior results and refrain from comparing their knee function to patients with TKA after OA. Surgeons should be aware of the challenges that PTOA TKA poses. Level of evidence Level III.

Survival and Clinical Outcomes after Unconstrained Total Knee Arthroplasty for Tibial Plateau Fractures–A Retrospective Study with Minimum 4-Year Follow-Up

“…In a recent systematic review, Syrikas et al [11] demonstrated a higher postoperative complication rate with infections being the most common, a higher revision rate and inferior patient-reported outcomes in patients with TKA following PTO when compared to those of OA.…”

“…Ultimately, PTO progresses and nonoperative treatment may fail. For end-stage PTO of the knee, total knee arthroplasty (TKA) is a common procedure that has been shown to alleviate pain and restore function [10,11].…”

“…Whereas some authors have demonstrated satisfactory functional outcomes for TKA in PTO similar to those performed for primary osteoarthritis (OA) [10,12,13], others have found inferior patient-reported outcome measures (PROs) and revision-free survival [11,14,15]. Less controversy exists regarding the higher rate of complications for TKA following PTO [10][11][12][14][15][16][17][18].…”

“…Whereas some authors have demonstrated satisfactory functional outcomes for TKA in PTO similar to those performed for primary osteoarthritis (OA) [10,12,13], others have found inferior patient-reported outcome measures (PROs) and revision-free survival [11,14,15]. Less controversy exists regarding the higher rate of complications for TKA following PTO [10][11][12][14][15][16][17][18]. Among the reasons for the higher complication rate is that in patients with PTO, arthroplasty is technically more demanding due to posttraumatic bone defects, remaining hardware, malalignment, scar tissue, limited range of motion and compromised soft tissue, thus requiring more time in the operating room [14].…”