Lower function, quality of life, and survival rate after total knee arthroplasty for posttraumatic arthritis than for primary arthritis

Figures & data

Table 1. Summary of the main characteristics of the patients in the 2 groups

	Primary arthritis (PA) group n = 407	Posttraumatic arthritis (PTA) group n = 33	p-value
Age (years) ^a	72 (9)	69 (11)	0.09
Gender (M:F)	132:275	18:15	0.01
BMI (kg/m^2) ^a	29 (5)	27 (5)	0.09
Previous knee surgeries (n) ^a	0.36 (0.73)	1.6 (0.93)	0.003
Charnley classification
A	323	27	0.7
B	84	6	0.7
C	0	0	–
Follow-up ^a	11 (3)	11 (3)	0.4

^a Mean (SD)

Table 2. Summary of the main characteristics of fractures and scar patterns in the PTA group

Mean delay from original trauma to TKA (SD) Initial management of the fracture:		14 (7) years
	Operatively	28
	Nonoperatively	5
Fracture location:	Intra-articular	22
	Extra-articular	11
Bone involved:	Tibia	23
	Femur	6
	Tibia and femur	4
AORI bone defect classification: ^a	Type 1	20
	Type 2	13
Number of scars:	1 scar	14
	2 scars	10
	3 scars and more	4

^a Anderson Orthopaedics Research Institute bone defect classification (Jacofsky el al. 2010).

Figure 1. A typical case: a 60-year-old active man with a history of fracture of the medial tibial plateau. TKA required use of stems and augments and a muscular flap. At 8 years, the patient is doing well but still has limitation of flexion at 105° and is limited during his activities of daily living. The implant is radiographically stable.

Table 3. Medium-term results of clinical outcomes and range of motion (ROM) in both groups preoperatively and at the last follow-up. Values are mean (SD)

	Primary arthritis (PA) group (n = 407)				Posttraumatic arthritis (PTA) group (n = 33)
	Preop.	At last FU	Improvement	p-value^a	Preop.	At last FU	Improvement	p-value^a	p-value^b	p-value^c
KSS
Knee	39 (18)	87 (16)	48	0.003	31 (11)	77 (15)	46	0.003	0.02	0.4
Function	55 (12)	89 (25)	34	0.008	44 (14)	81 (10)	37	0.008	0.03	0.3
ROM (°)	116 (16)	127 (13)	11	0.001	83 (19)	108 (17)	25	< 0.001	< 0.001	< 0.001

^a Comparison between preoperative results and results at last follow-up in each group.

^b Comparison of results between the 2 groups at the last follow-up.

^c Comparison of improvement between 2 groups.

FU: follow-up; KSS: Knee Society score; ROM: range of motion.

Figure 2. Postoperative results of the KOOS for the 2 groups (the primary arthritis (PA) group and the posttraumatic arthritis (PTA) group). ADL: activities of daily living; SA: sport activity; QoL: quality of life. There were significant differences between groups in all dimensions of KOOS (p < 0.001).

Table 4. Overall rate of complications a

	PA group n = 407	PTA group n = 33
Prosthesis revised
Deep infection		2
Aseptic loosening		1
Reoperation
Knee stiffness	1	2
Patellar clunk syndrome		1
Heterotopic ossification		1
Hematoma	1
Chronic patellar dislocation	1
Early polyethylene wear	1
Superficial wound infection	1
Overall complications (p < 0.001)	5	7

^a At the last follow-up, the overall rate of complications was higher in the PTA group than in the PA group (p < 0.001). Complications were reported as revision if the prosthesis was removed and replaced, and as reoperation when no implant exchange was performed.

Jacofsky DJ, Della Valle CJ, Meneghini RM, Sporer SM, Cercek R M; American Academy of Orthopaedic Surgeons. Revision total knee arthroplasty: what the practicing orthopaedic surgeon needs to know. J Bone Joint Surg (Am) 2010; 92: 1282-92.

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