Periprosthetic fracture as the predominant indication for reoperation after cemented posterior-stabilized total knee arthroplasty with highly cross-linked polyethylene without tourniquet use: a 10-year survivorship analysis.

Abstract

Although mechanical failures were common causes of reoperation after total knee arthroplasty (TKA), advances in implant design may have shifted the predominant indications. This study aimed to identify the major causes of reoperation after implantation of a clinically proven posterior-stabilized (PS) prosthesis using modern highly cross-linked polyethylene. We reviewed 333 consecutive PS TKAs using the Scorpio NRG, an implant that has been progressively refined from earlier successful TKA designs. Both the femoral and tibial components were cemented without the use of a tourniquet. All patients received highly cross-linked X3 polyethylene. The primary outcome was reoperation for any reason, and the secondary outcome was revision surgery involving implant removal. Survivorship was estimated using the Kaplan-Meier method. The 10-year survival rate free from reoperation was 97.0% (95% CI, 91.7-98.1%). The most frequent indication was periprosthetic fracture (n = 5), followed by superficial infection (n = 1), deep infection (n = 1) and tibial baseplate loosening (n = 1). The 10-year survival free from revision involving implant removal was 99.3% (95% CI, 97.2-99.8%). No reoperations were performed for polyethylene wear, femoral loosening, or tibiofemoral instability. In TKA with the Scorpio NRG-PS and X3 polyethylene, periprosthetic fracture was the leading cause of reoperation at 10 years. These findings suggest that the failure modes have shifted in cemented PS TKA using established implants and modern highly cross-linked polyethylene and highlight the importance of osteoporosis management for optimizing long-term outcomes.