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Poorer TKA results seen in patients with post-traumatic arthritis vs. OA

Issue: Issue 3 2010

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NEW ORLEANS — Total knee arthroplasty may lead to significantly lower function, quality of life and 10-year survivorship results for patients with post-traumatic arthritis compared to patients with osteoarthritis, according to the results of a study presented here.

“We saw significantly lower results for function, range of motion and quality of life for post-traumatic arthritis,” Jean-Noel A. Argenson, MD, said during his presentation at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons.

For their research, Argenson and colleagues performed a retrospective study comparing the results of 33 patients who had a total knee arthroplasty (TKA) to treat post-traumatic arthritis following an intra-articular or extra-articular fracture with a group of 407 patients who underwent TKA for primary osteoarthritis (OA). All of the patients received cemented total knee prostheses and had their procedures performed at the same institution.

The patients in the post-traumatic arthritis group had a mean age of 69 years and had an average delay of 14 years between the time of their fracture and surgery. The comparison group had a mean age of 72 years.

The investigators measured the patients’ Knee Society Scores and determined their quality of life using five categories of the Knee Osteoarthritis Outcome Score.

Investigators found that the mechanical alignment was restored in most cases in both groups. However, they discovered that the post-traumatic arthritis group showed significantly lower improvements in knee and function Knee Society Scores compared to those obtained in the OA group.

They also found a significantly lower range of motion in the post-traumatic arthritis group and significantly lower quality of life outcomes in the post-traumatic arthritis group. In addition, they discovered that the post-traumatic arthritis cohort had a 78.8% survivorship at 10 years compared to a 98.8% 10-year survivorship in the OA group. — by Gina Brockenbrough

Reference:

• Argenson JN, Parra CG, Pauly V, Aubaniac J-M, Parratte S. Quality of life, function and survival after total knee arthroplasty for post-traumatic arthritis. Paper 505. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13. New Orleans.

• Jean-Noel A. Argenson, MD, can be reached at the Service de Chirurgie Orthopédique, Center for Arthritis Surgery, Hôpital Sainte-Marguerite, Aix-Marseille University, 270, Boulevard Sainte-Marguerite, 13009 Marseille, France; e-mail: jean-noel.argenson@ap-hm.fr. He is a paid consultant or employee; receives royalties and research or institutional support from Zimmer.

Knee arthroplasty is a rather challenging operation and results show a clear learning curve. In that view it was easy to understand that in general, trauma surgeons with less experience in knee arthroplasty normally show different results following total knee implantations than knee ultra specialists. Therefore it is interesting that in this article, Prof. Argenson and his colleague could demonstrate the results in the hands of experienced knee arthroplasty surgeons. They could show in a series of 450 implantations that results regarding knee function, range of motion and quality of life are significantly better in patients with preoperative degenerative destructions in comparison to patients with post-traumatic knee changes. Since the average delay between time of fracture and surgery was 14 years, their results demonstrate the effects of bony and soft tissue impairment, even after such a long time.

In summary it can be stated that this article shows an excellent way that the preoperative conditions play a major role for the later results even in the hands of highly specialized knee surgeons.

– Prim. Univ.-Prof. Dr. N. Böhler, Hon. FRCS
Head of orthopaedic department, Allgemeines Krankenhaus Linz