Knee replacement complications in post-traumatic osteoarthritis patients
In a recent paper, doctors from NYU Langone Medical Center, Hospital for Joint Diseases suggest that total knee arthroplasty (replacement) is often the best answer for end-stage, post-traumatic osteoarthritis after intra-articular (inside) and periarticular (around) osteoarthritic fractures the knee.
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However, total knee replacement in the setting of post-traumatic osteoarthritis is often considered more technically demanding surgery and the surgical outcomes are typically worse for these patients. The goal of the NYU paper was to create a new classification label for post-traumatic osteoarthritis patients and improve medical documentation and improve patient care.
- The researchers looked at post-traumatic osteoarthritis patients who suffered from osteoarthritis as a result of high demand or athletic activity. These were on average were younger and healthier than the primary total knee replacement population (older patients with degenerative arthritis from wear and tear).
- The the healthier post-traumatic total knee replacement group had the following complications:
- higher rates of superficial surgical site infections,
- bleeding requiring transfusion,
- prolonged operative time,
- increased length of hospital stay,
- and 30-day hospital readmission.1
In a similar study, doctors at Duke University also recognized that Total Knee Arthroplasty as an important treatment for post-traumatic arthritis. However, these researchers also found complications that should not be expected in a mostly healthy patient population.
- Higher rate of infection around the knee implant
- cellulitis (skin infection)
- seroma (fluid build)
- knee wound complications (problems at the surgical incisions)
- Need for a revision surgery.2
Options for knee replacement in post-traumatic arthritis
Doctors at Italy’s Bologna University looked at osteochondral allografts (cartilage transplantation from a donor) for their treatment of end-stage arthritis in younger post-traumatic arthritis patients. Here are their troubling findings:
- Bipolar fresh osteochondral allografts (Cartilage transplant) recently became a fascinating option for articular cartilage replacement, in particular in those young patients non-suitable for traditional replacement because of age.
- HOWEVER Bipolar fresh osteochondral allograft in the knee remains an inapplicable option in the treatment of post-traumatic end-stage arthritis of the young patient, due to the high rate of failure.3
The need for success options are obvious. Doctors at the University of Alberta and the University of Calgary in Canada found that young athletes with post-traumatic knee arthritis had significant and rapid physical declines between the time of injury and the onset of arthritis.
In this study the Canadian researchers looked at:
- Patients in the age range of 15-26.
- Fifty with a sport-related intra-articular knee injury sustained 3-10 years previously and 50 uninjured age, sex and sport matched controls.
- Injured participants demonstrated poorer KOOS outcomes. KOOS is The Knee injury and Osteoarthritis Outcome Score based on what the patient reports in their pain, function, quality-of-life, and sport/recreation participation.
- Many patients became overweight/obese following their knee injury.
The study’s authors reiterated in their conclusion: “This study provides preliminary evidence that youth/young adults following sport-related knee injury report more symptoms and poorer function, and are at greater risk of being overweight/obese 3-10 years post-injury compared to matched uninjured controls.”4
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- Platelet Rich Plasma Therapy for Knee Osteoarthritis
- Prolotherapy knee osteoarthritis injections
- Hyaluronic Acid Injections for knee osteoarthritis
- Prolotherapy for Grade IV Knee Osteoarthritis
- Stem Cells and Prolotherapy for Knee Osteoarthritis and Cartilage Regeneration
Are you a candidate for our non-surgical treatments? Ask our specialists:
- Ross Hauser, MD | Danielle Steilen-Matias, PA-C | Katie Worsnick, PA-C | David Woznica, MD
1 Kester BS, Minhas SV, Vigdorchik JM, Schwarzkopf R. Total Knee Arthroplasty for Posttraumatic Osteoarthritis: Is it Time for a New Classification? J Arthroplasty. 2016 Aug;31(8):1649-1653.e1. [Pubmed]
2 Bala A, Penrose CT, Seyler TM, Mather RC 3rd, Wellman SS, Bolognesi MP. Outcomes after Total Knee Arthroplasty for post-traumatic arthritis. Knee. 2015 Dec;22(6):630-9. doi: 10.1016/j.knee.2015.10.004. Epub 2015 Oct 31.
3 Giannini S, Buda R, Ruffilli A, Pagliazzi G, Ensini A, Grigolo B, Desando G, Vannini F. Failures in bipolar fresh osteochondral allograft for the treatment of end-stage knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2015 Jul;23(7):2081-9. doi: 10.1007/s00167-014-2961-1. [Pubmed]
4 Whittaker JL, Woodhouse LJ, Nettel-Aguirre A, Emery CA. Outcomes associated with early post-traumatic osteoarthritis and other negative health consequences 3-10 years following knee joint injury in youth sport. Osteoarthritis Cartilage. 2015 Jul;23(7):1122-9. doi: 10.1016/j.joca.2015.02.021. Epub 2015 Feb 26. [Pubmed]