Conversion Total Knee Arthroplasty in Patients Who Have Periarticular Hardware: One Operation May Be Enough.

Abstract

It is not infrequent to encounter patients undergoing total knee arthroplasty (TKA) who have periarticular hardware in place from prior surgical intervention(s). The optimal management of hardware around the knee is not known, with some surgeons preferring to remove the hardware simultaneously, while others may stage hardware removal and TKA (staged). This study compared the outcome of patients who have hardware in place who underwent simultaneous or staged management of the hardware and TKA. This retrospective study included 266 patients undergoing conversion TKA (CTKA) between 2000 and 2023. Simultaneous hardware removal at the time of TKA was performed in 170 patients, while 96 patients underwent staged procedures. Primary outcomes included the rate of 90-day postoperative infection and postoperative complications. The type of hardware removal was delineated as major hardware (plate and intramedullary nail) versus minor hardware (screw, pin, staple, and button). There were no statistically significant differences in patient age, sex, body mass index (BMI) and comorbidities between the two cohorts. Patients who had previous infections were more likely to have a staged procedure (P = 0.002), with no significant difference in the rate of infection in the staged cohort (6.25%) compared to the simultaneous (2.35%) (P = 0.176). The overall rate of TKA complications was not significantly different between the groups (13.5% in simultaneous, 20.8% in staged, P = 0.167). Simultaneous procedures were more likely to include minor hardware removal (52.9%) compared to major hardware removal for staged procedures (67.7%) (P < 0.001). Based on the outcome of this study, it appears that removal of hardware and performing TKA in two separate operations may not be necessary in all patients. Only those patients who had a prior or active infections around the knee may be candidates for staged hardware removal and conversion TKA. Future studies with larger cohorts are needed to validate these findings and better standardize the surgical approach in this setting.