Undergoing cartilage procedures before total knee arthroplasty is not associated with worse postoperative functional outcomes, readmission rates or complication rates

Document Type

Article

Publication Date

11-14-2024

Publication Title

Knee Surgery, Sports Traumatology, Arthroscopy

Abstract

Purpose: Patients undergoing total knee arthroplasty (TKA) with prior knee cartilage surgery have unclear outcomes in the literature. This study compared outcomes after TKA in patients with or without prior knee cartilage surgery, and we hypothesized there would be equivocal outcomes between groups. Methods: A retrospective matched case–control study was conducted on patients from our institution who underwent ipsilateral cartilage procedure(s) and TKA (cases) or TKA alone (controls) from 2000 to 2022. Cartilage procedures included Autologous Chondrocyte Implantation (ACI), Osteochondral Allograft (OCA) and Microfracture (MFx). Matching was performed in 1:3 (case:control) ratio for age, sex, body mass index, Charlson Comorbidity Index, pre-TKA Kellgren–Lawrence osteoarthritis grade and follow-up for knee injury and osteoarthritis outcome score for joint replacement (KOOS-JR). Mann–Whitney U and χ2 analyses were conducted, with significance being a p < 0.05. A priori power analysis required 29 patients per cohort to reach a clinically detectable difference of 11 for KOOS-JR. Results: Forty-three cases (one ACI, eight OCA and 34 MFx) and 129 controls were included after matching, with no significant demographic differences. Cases underwent TKA after cartilage surgery at a mean of 4.6 years. No significant differences existed between cases and controls for the preoperative KOOS-JR (45.2 vs. 47.8; p = 0.353), postoperative KOOS-JR (69.8 vs. 69.9; p = 0.974) or Delta KOOS-JR (30.4 vs. 26.0; p = 0.387). No significant differences existed for 90-day readmission rates (4.7% vs. 2.3%; p = 0.600) or revision TKA rates (11.6% vs. 5.4%; p = 0.177). Conclusion: Patients with and without prior cartilage surgery experience similar functional outcomes, readmission rates and revision rates after TKA on the same knee. Patients who are candidates for TKA with a history of cartilage surgery may be counselled that their surgical history on that knee does not convey the risk of worse functional outcomes. Level of Evidence: Level III case–control study.

PubMed ID

39540406

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