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Abstract
ObjectiveTo investigate the outcomes of total knee arthroplasty (TKA) in patients with a prior femoral or tibial fracture, and identify the risk factors for surgical site complications and reoperations.MethodsSeventy‐one TKAs performed in 71 patients with a prior tibial or femoral fracture between January 2005 and December 2016 were reviewed retrospectively. Forty males (40 knees) and 31 females (31 knees) were included. The mean age at the time of TKA was 59.2 (range, 29–83) years. Outcomes were assessed using the Knee Society score before surgery and at the final follow‐up visit. The patients' satisfaction rates were evaluated. Complications and reoperations were recorded by clinical and radiographic assessment. Logistic regression analysis was used to identify the risk factors for surgical site complications and reoperations.ResultsThe median follow‐up period was 4.7 (range, 3.2–7.1) years. The median knee range of motion increased from 90° preoperatively to 110° at the latest follow‐up. The Knee Society knee score and function score improved from 35 (30, 40) and 40 (30, 50) to 90 (82, 93) and 90 (65, 100), respectively. The degree of overall satisfaction after TKA surgery was very satisfied in 41 patients, satisfied in 20 patients, neutral in four patients, dissatisfied in four patients, and very dissatisfied in two patients. The overall satisfaction (very satisfied and satisfied) rate was 85.9% (61 knees). Twelve knees (16.9%) had 19 surgical site complications. Six knees (8.3%) underwent reoperations, including one revision due to periprosthetic joint infection, one debridement and implant retention for superficial infection, two debridements for delayed wound healing, one open reduction and internal fixation for supracondylar fracture, and one re‐fixation and bone grafting for hardware failure after a combined femoral shaft osteotomy and TKA. Preoperative patella baja was diagnosed in 12 knees, and was identified as a risk factor for surgical site complications and reoperations.ConclusionsTKA for post‐fracture osteoarthritis significantly relieved pain and improved function, but the incidence of surgical site complications and reoperations was high. Preoperative patella baja was a risk factor for surgical site complications and reoperations.
Highlights
Post-traumatic osteoarthritis (PTOA) of the knee is defined as the development of arthritis following an acute traumatic episode commonly associated with significant ligamentous injury or intra/extra-articular fracture[1]
The degree of overall satisfaction after total knee arthroplasty (TKA) surgery was very satisfied in 41 patients, satisfied in 20 patients, neutral in four patients, dissatisfied in four patients, and very dissatisfied in two patients
Preoperative patella baja was diagnosed in 12 knees, and was identified as a risk factor for surgical site complications and reoperations
Summary
Post-traumatic osteoarthritis (PTOA) of the knee is defined as the development of arthritis following an acute traumatic episode commonly associated with significant ligamentous injury or intra/extra-articular fracture[1]. PTOA represents 9.8% of the overall prevalence of symptomatic knee osteoarthritis, costing an estimated $40 bn in direct and indirect costs[2]. PTOA may be caused by either intra-articular fractures, which result in direct ligament and osteochondral injury, and cause joint instability and incongruity, or secondary to malunion of extra-articular fractures around the knee, which alters weight-bearing axis of the lower limb, thereby increases the joint stress and accelerates the joint degeneration. Bala et al.[6] evaluated the impact of PTOA versus primary osteoarthritis on postoperative outcomes after TKA in a large database of Medicare patients, and found PTOA patients had higher incidence of periprosthetic infection (OR 1.72, P < 0.001), cellulitis or seroma (OR 1.19, P < 0.001), knee wound complications (OR 1.80, P < 0.001), TKA revision (OR 1.23, P = 0.01), and arthrotomy/incision and drainage (OR 1.55, P < 0.001)
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