TKA outcomes after prior bone and soft tissue knee surgery
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KNEE
TKA outcomes after prior bone and soft tissue knee surgery Se´rgio Rocha Piedade • Alban Pinaroli Elvire Servien • Philippe Neyret
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Received: 19 October 2011 / Accepted: 9 July 2012 Ó Springer-Verlag 2012
Abstract Purpose Bone surgery around the knee joint could represent a more traumatic prior surgical procedure compared to soft tissue knee surgery and may predispose to differing postoperative total knee arthroplasty (TKA) outcomes. The objective of this study was to analyse the postoperative results as well as complications and failures in two groups of patients that had undergone knee surgery prior to primary TKA (bone surgery and soft tissue surgery) when compared to the no prior surgery group. Methods A retrospective and cohort series of 1,474 primary TKA were evaluated at minimum follow-up period of 2 years: 1,119 primary TKA underwent no prior surgery (1,119 patients) (group A), 85 primary TKA (85 patients) (group B) had prior bone procedure [high tibial osteotomy (n = 64), tibial plateau fracture (n = 10) and patellar realignment (n = 11)], and third group of 146 primary TKA (146 patients) (group C) had undergone a soft tissue procedure [arthroscopy (n = 60) and menisectomy (n = 86)] before primary TKA. All the patients underwent a clinical and radiological evaluation as well as International Knee Society (IKS) scores. Se´rgio Rocha Piedade: Post Doctorate Scholarship by CNPq— National Council for Scientific and Technological Development/ Brazil. S. R. Piedade Department of Orthopedics and Traumatology, Exercise and Sports Medicine Group, School of Medical Sciences, State University of Campinas, UNICAMP, Campinas, Brazil e-mail: [email protected] A. Pinaroli E. Servien P. Neyret (&) De´partement d’Orthopedie du Genou, Centre Albert Trillat, Hoˆpital de la Croix Rousse, 103 Grande rue de la Croix Rousse, 69004 Lyon, France e-mail: [email protected]
Results Preoperatively, group B had 40 % of cases classified as stage IV knee arthritis (p \ 0.02); while 57 % of cases in group A showed higher levels of knee malalignment (p = 0.001) and group C had lower BMI (p = 0.001). Intraoperative complications revealed no difference. Although group B had the poorest postoperative mean values of knee flexion, TKA procedure improved the preoperative mean values of knee flexion in all the study groups. The postoperative complications were more prevalent in group C (p \ 0.001), while the percentage of revision TKA was similar for all study groups (p = 0.5). At 120-month follow-up, the Kaplan–Meier survival curve rates showed no difference (p = 0.29). Conclusion This study confirms that prior knee surgery could be considered a clinical condition predisposed to higher postoperative complication rate in primary TKA compared to the no prior surgery group. After analysing the three study groups, group C showed a higher rate of postoperative local complications and lower IKS knee scores, while the group B showed the poorest postoperative mean values of knee flexion as well as the need for extended surgical
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