Predictors of reoperation and survival experience for primary total knee arthroplasty in young patients with degenerative and inflammatory arthritis

Hannah J Szapary; Alexander Farid; Vineet Desai; Helena Franco; John E Ready; Antonia F Chen; Jeffrey K Lange

doi:10.1007/s00402-024-05299-1

Predictors of reoperation and survival experience for primary total knee arthroplasty in young patients with degenerative and inflammatory arthritis

Arch Orthop Trauma Surg. 2024 Apr 13. doi: 10.1007/s00402-024-05299-1. Online ahead of print.

Authors

Hannah J Szapary^{1

2}, Alexander Farid^{3

4}, Vineet Desai^{3

4}, Helena Franco^{3

4}, John E Ready³, Antonia F Chen³, Jeffrey K Lange³

Affiliations

¹ Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA. hannah_szapary@hms.harvard.edu.
² Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. hannah_szapary@hms.harvard.edu.
³ Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
⁴ Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.

PMID: 38613613
DOI: 10.1007/s00402-024-05299-1

Abstract

Introduction: While total knee arthroplasty (TKA) is typically implemented in patients > 65 years old, young patients may need to undergo TKA for pain relief and functional improvement. Current data are limited by older cohorts and short-term survival rates. This study aimed to examine a large sample size of patients with degenerative and inflammatory conditions who underwent primary TKA at a young (≤ 40) age to identify predictors of reoperation, as well 15-year survivorship.

Materials and methods: A retrospective study was performed on 77 patients (92 surgeries) who underwent primary TKA at ≤ 40 years old, between January 1990 and January 2020. Patient charts were reviewed and a multivariable logistic regression model identified independent predictors of reoperation. Kaplan-Meier analysis was employed to build survival curves and log-rank tests analyzed survival between groups.

Results: Of the 77 patients, the median age at the time of surgery was 35.7 years (IQR: 31.2-38.7) and median follow-up time was 6.88 years. Twenty-one (22.8%) primary TKAs underwent 24 reoperations, most commonly due to stiffness (n = 9, 32.1%) and infection (n = 13, 46.4%) more significantly in the OA group (p = 0.049). There were no independent predictors of reoperation in multivariable analysis, and 15-year revision-free survivorship after TKA did not differ by indication (77.3% for OA/PTOA vs. 96.7% for autoimmune, p = 0.09) or between ≤ 30 and 31-40 year age groups (94.7% vs. 83.6%, p = 0.55).

Conclusions: In this cohort of patients ≤ 40 years old, revision-free survival was comparable to that reported in the literature for older TKA patients with osteoarthritis/autoimmune conditions (81-94% at 15-years). Though nearly a quarter of TKAs required reoperation and causes of secondary surgery differed between degenerative and inflammatory arthritis patients, there were no significant predictors of increased reoperation rate. Very young patients ≤ 30 years old did not have an increased risk of revision compared to those aged 31-40 years.

Keywords: Knee arthroplasty; Revision; Survivorship; Young cohort.