10-Year Outcomes of Total Knee Arthroplasty for Fracture Compared to Osteoarthritis Indications
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 US 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 posttraumatic OA within five years prior to TKA, excluding primary OA) or OA-indicated (primary OA within five years, excluding prior knee fracture and posttraumatic 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, 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; risk ratio =…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 1,062 participants or records.
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