10-Year Outcomes of Total Knee Arthroplasty for Fracture Compared to Osteoarthritis Indications.
TL;DR
Fracture-indicated TKA was associated with significantly higher 10-year risks of PJI and revision compared with OA-indicated TKA, supporting heightened perioperative infection mitigation and extended surveillance in this high-risk population.
Abstract
Background
Total knee arthroplasty (TKA) performed after periarticular knee fracture is technically complex and has demonstrated higher complication rates within five years compared with osteoarthritis (OA)-indicated TKA. Comparative outcomes beyond five years in a large United States cohort remain limited. We compared 10-year surgical outcomes after fracture-indicated versus OA-indicated primary TKA.
Methods
A retrospective cohort study was performed using a large, nationally federated electronic health record database. Adults undergoing primary TKA were categorized as fracture-indicated (history of distal femoral or proximal tibia fracture with post-traumatic OA within five years prior to TKA, excluding primary OA) or OA-indicated (primary OA within five years, excluding prior knee fracture and post-traumatic OA). Exclusions included inflammatory arthritis, joint infection, pyogenic arthritis, and bone malignancy. Cohorts were propensity-score matched 1:1 for age, sex, race, ethnicity, Charlson Comorbidity Index, overweight and obesity, nicotine dependence, osteoporosis without a current pathological fracture, and vitamin D deficiency. The primary 10-year outcomes were all-cause revision, periprosthetic joint infection (PJI), aseptic loosening, periprosthetic fracture (PPF), and secondary fragility fracture. After matching, 1,062 patients remained in each cohort.
Results
At 10 years, fracture-indicated TKA demonstrated a higher risk of revision (5.8 versus 3.0%, P = 0.002; relative risk (RR) = 1.91, 95% confidence interval (CI): 1.26 to 2.90) and PJI (4.7 versus 2.3%, P = 0.003; RR = 2.06, 95% CI: 1.27 to 3.33). Aseptic loosening and secondary fragility fracture did not differ. Time-to-event analysis showed increased revision (hazard ratio = 3.35, 95% CI: 2.13 to 5.27; log-rank P < 0.001).
Conclusion
Fracture-indicated TKA was associated with significantly higher 10-year risks of PJI and revision compared with OA-indicated TKA, supporting heightened perioperative infection mitigation and extended surveillance in this high-risk population.