Lower survival, higher surgical complexity, but no difference in physical functioning and pain in total knee arthroplasty following osteotomy versus primary total knee arthroplasty without osteotomy: Analysis of 189,932 procedures of the Dutch Arthroplasty Register.

Abstract

Total knee arthroplasty (TKA) following an osteotomy around the knee might be technically more challenging and yield inferior outcome compared with primary TKA. The aim of this study was to investigate the survival, use of revision components and clinical outcome of TKAs postosteotomy compared with primary TKAs. Patients from the Dutch Arthroplasty Register who underwent TKA after osteotomy or primary TKA with osteoarthritis as primary diagnosis from 2007 to 2022 and aged ≥18 years at the time of the procedure were selected. Kaplan-Meier and multivariable Cox proportional hazards regression analyses were used to estimate the survival and hazard ratio (HR) for revision. The use of TKA revision components was analysed and used as stratification factor. Patient-reported outcome measures (PROMs) (Numeric Rating Scale for pain at rest and during activity, Knee injury and Osteoarthritis Outcome Score Physical Function Short Form and Oxford knee score) were assessed preoperatively and 6 and 12 months postoperatively. A significantly higher survival of the TKA until 15-year follow-up was found in primary TKAs, with a median survival of 4.1 years (interquartile range 5.0) compared to TKAs following osteotomy. The proportion of TKA revision components was higher after a previous osteotomy (2.5 vs. 0.5%; p < 0.001). A higher TKA revision risk was found in the primary component group after a previous osteotomy compared to primary TKAs (HR: 1.2, 95% confidence interval: 1.14-1.35). The use of revision components increased the risk for a TKA revision in both groups. No differences in PROMs between groups were found. This study showed that a previous osteotomy is associated with decreased implant survival in subsequent TKAs, especially if a TKA component with stems and/or augmentations was used. Level II.