Increased risk of early and medium-term revision after post-fracture total knee arthroplasty

Abstract

Background and purposeTotal knee arthroplasty (TKA) due to posttraumatic fracture osteoarthritis (PTFA) may be associated with inferior prosthesis survival. This study is the first registry-based study solely addressing this issue. Both indications and predictors for revision were identified.Patients and methods52,518 primary TKAs performed between 1997 and 2013 were retrieved from the Danish Knee Arthroplasty Register (DKR). 1,421 TKAs were inserted due to PTFA and 51,097 due to primary osteoarthritis (OA). Short-term (< 1 year), medium-term (1–5 years), and long-term (> 5 years) implant survival were analyzed using Kaplan-Meier analysis and Cox regression after age stratification (< 50, 50–70, and >70 years). In addition, indications for revision and characteristics of TKA patients with subsequent revision were determined.ResultsDuring the first 5 years, TKAs inserted due to PTFA had a higher risk of revision than OA (with adjusted hazard ratio ranging from 1.5 to 2.4 between age categories). After 5 years, no significant differences in the risk of revision were seen between the groups. Infection and aseptic loosening were the most common causes of revision in both groups, but TKA instability was a more frequent indication for revision in the PTFA group. In both groups, the revision rates were higher with younger age and extended duration of primary surgery.InterpretationWe found an increased risk of early and medium-term revision of TKAs inserted due to previous fractures in the distal femur and/or proximal tibia. Predictors of revision such as age <50 years and extended duration of primary surgery were identified, and revision due to instability occurred more frequently in TKAs performed due to previous fractures.

Primary Total knee Arthroplasty: A Viable Surgical Option for Complex Tibial Plateau Fractures in Elderly

“…47 It was 3% following tibial plateau fractures and 4% for displaced fractures treated by ORIF. Data from the Danish knee arthroplasty registry were published earlier this year, 48 confirming the same results after studying the outcomes of a larger scale of patients. The authors recalled the results of 1,421 TKAs that were implanted due to secondary OA.…”

“…The authors found an increased risk of early and medium-term revision of TKAs inserted after intra-articular fractures. 48 Our study has some limitations. This includes the limited number of patients reported.…”

Total Knee Arthroplasty in Patients with Prior Femoral and Tibial Fractures: Outcomes and Risk Factors for Surgical Site Complications and Reoperations

“…reported that patients with previous fractures around the knee were more likely to experience surgical site complications and an increase in 90‐day readmission rate after conversion to TKA in contrast to patients with previous soft‐tissue injuries about the knee. El‐Galaly et al . reported an increased risk of early‐ and medium‐term TKA revision due to previous fractures of the distal femur and/or proximal tibia.…”

“…Ge et al 9 reported that patients with previous fractures around the knee were more likely to experience surgical site complications and an increase in 90-day readmission rate after conversion to TKA in contrast to patients with previous soft-tissue injuries about the knee. El-Galaly et al 10 reported an increased risk of early-and medium-term TKA revision due to previous fractures of the distal femur and/or proximal tibia. Houdek et al 1 found that patients with a previous distal femoral fracture were at increased risk for postoperative complications (HR 1.47) compared with patients who had a history of proximal tibial fracture.…”

“…Ge et al 9 reported that patients with previous site-specific fractures suffered higher surgical site complications (22% vs 4.4%) and 90-day readmissions (14.8% vs 2.2%) after conversion TKA than patients with previous soft-tissue knee trauma. El-Galaly et al 10 found an increased risk of early and medium-term revision of TKAs due to previous fractures in the distal femur and/or proximal tibia. To the best of our knowledge, there is a scarcity of studies pertaining to the risk factors for surgical site complications and reoperations after TKA in patients with PTOA secondary to prior femoral and tibial fractures.…”