Total Knee Arthroplasty in Patients with Retention of Prior Hardware Material: What is the Outcome?

Document Type : RESEARCH PAPER


1 Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA

2 Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran


Background: There is an information gap in literature regarding postoperative outcome of total knee arthroplasty (TKA)
in patients with hardware in-situ from the previous knee surgery. The present study aims to evaluate impact of retained
hardware on short-term outcome of TKA patients.
Methods: Perioperative radiographs of patients who had undergone TKA between 2007 and 2012 were reviewed
and patients in whom partial or complete retention of hardware was evident after TKA were included. These patients
were matched in 1 to 2 ratio based on age (+/- 2 years), gender, surgeon and year of surgery to a group of patients
that underwent primary TKA without hardware in the affected knee. The average follow up of these patients was 43.45
(range 12-155.2) months. Complication rates were compared between the two groups using statistical tests that took
into account the matched data structure.
Results: We included a total of 55 cases and 110 controls. The incidence of complications was higher, although not
all statistically significant, in the case group. Only mechanical complications were significantly different in the cases
group (5.5% versus 0%, P=0.01). Time to event analysis using the mixed-effects Cox model didn’t show a statistically
significant difference between two groups for various outcomes.
Conclusion: Presence of retained hardware around the knee may predispose the patient to a higher rate of
complications particularly mechanical complications of the implant after TKA. Further studies are required to investigate
impact of retained hardware around the knee in patients undergoing TKA.


Main Subjects

1. Brown TD, Johnston RC, Saltzman CL, Marsh JL,
Buckwalter JA. Posttraumatic osteoarthritis: a first
estimate of incidence, prevalence, and burden of
disease. J Orthop Trauma. 2006; 20(10):739-44.
2. Weiss NG, Parvizi J, Hanssen AD, Trousdale RT,
Lewallen DG. Total knee arthroplasty in posttraumatic
arthrosis of the knee. J Arthroplasty. 2003;
18 (3 Suppl 1):23–6.
3. Kim J, Nelson CL, Lotke PA. Stiffness after total knee
arthroplasty. Prevalence of the complication and
outcomes of revision. J Bone Joint Surg Am. 2004; 86-
4. Iorio R, Della Valle CJ, Healy WL, Berend KR,
Cushner FD, Dalury DF, et al. Stratification of
standardized TKA complications and adverse events:
a brief communication. Clin Orthop Relat Res. 2014;
5. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori
TG. CDC definitions of nosocomial surgical site
infections, 1992: a modification of CDC definitions of
surgical wound infections. Am J Infect Control. 1992;
6. Lonner JH, Pedlow FX, Siliski JM. Total knee
arthroplasty for post-traumatic arthrosis. J
Arthroplasty. 1999; 14(8):969–75.
7. Roffi RP, Merritt PO. Total knee replacement
after fractures about the knee. Orthop Rev 1990;
8. Saleh KJ, Sherman P, Katkin P, Windsor R, Haas S,
Laskin R, et al. Total knee arthroplasty after open
reduction and internal fixation of fractures of the
tibial plateau: a minimum five-year follow-up study. J
Bone Joint Surg Am. 2001; 83-A(8):1144–8.
9. Parratte S, Bonnevialle P, Pietu G, Saragaglia D,
Cherrier B, Lafosse JM. Primary total knee arthroplasty
in the management of epiphyseal fracture around
the knee. Orthop Traumatol Surg Res. 2011; 97(6
10. Papadopoulos EC, Parvizi J, Lai CH, Lewallen DG.
Total knee arthroplasty following prior distal femoral
fracture. Knee. 2002; 9(4):267–74.
11. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J.
Periprosthetic joint infection: the incidence, timing,
and predisposing factors. Clin Orthop Relat Res. 2008;
12. Klatte TO, Schneider MM, Citak M, Oloughlin P,
Gebauer M, Rueger M, et al. Infection rates in patients
undergoing primary knee arthroplasty with preexisting
orthopaedic fixation-devices. Knee 2013;
13. Suzuki G, Saito S, Ishii T, Motojima S, Tokuhashi Y,
Ryu J. Previous fracture surgery is a major risk factor
of infection after total knee arthroplasty. Knee Surg
Sports Traumatol Arthrosc. 2011; 19(12):2040–4.
14. Board TN, Karva A, Board RE, Gambhir AK, Porter
ML. The prophylaxis and treatment of heterotopic
ossification following lower limb arthroplasty. J Bone
Joint Surg Br. 2007; 89(4):434–40.
15. Freeman TA, Parvizi J, Della Valle CJ, Steinbeck
MJ. Reactive oxygen and nitrogen species induce
protein and DNA modifications driving arthrofibrosis
following total knee arthroplasty. Fibrogenesis Tissue
Repair. 2009; 2(1):5-16.