1. Conferences Overview
    2. Deutscher Kongress für Orthopädie und Unfallchirurgie 2025 (DKOU 2025)
    3. Prior knee osteotomy or osteosynthesis Increases revision rates but does not affect long-term mortality in total knee arthroplasty: An eight-year matched registry study
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German Congress of Orthopaedics and Traumatology (DKOU 2025)

Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC), Deutsche Gesellschaft für Unfallchirurgie (DGU), Berufsverband für Orthopädie und Unfallchirurgie (BVOU)
28.-31.10.2025
Berlin


Meeting Abstract

Prior knee osteotomy or osteosynthesis Increases revision rates but does not affect long-term mortality in total knee arthroplasty: An eight-year matched registry study

Nele Wagener 1
Alexander Grimberg 2
Yinan Wu 2
Christian Hipfl 1
Sebastian Hardt 1
1Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
2Endoprothesenregister Deutschland (EPRD gGmbH), Berlin, Deutschland

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Objectibes and questions: Total knee arthroplasty (TKA) is the gold standard for advanced knee osteoarthritis when conservative treatments fail. Yet the effects of prior osteotomy or osteosynthesis on long-term TKA outcomes remain controversial. This study examines whether such history influences revision risk and mortality.

Material and methods: Data from the German Arthroplasty Registry (EPRD), with 394,454 TKA cases, were analyzed. Mahalanobis matching (age, sex, BMI, subgroup, Elixhauser) formed cohorts of 2,301 (with vs. without osteotomy/osteosynthesis). Outcome parameters were prosthesis survival, revision and mortality rates.

Results: After one year, patients with prior osteotomy or osteosynthesis showed a significantly higher revision rate (4.1% vs. 2.4%, P=0.007). This difference persisted over time, resulting in five year cumulative revision rates of 8.3% (95% CI: 7.0–9.7) vs. 5.8% (95% CI: 4.9–6.9; P=0.006) and eight-year rates of 9.4% (95% CI: 7.9–11.3) vs. 7.3% (95% CI: 5.7–9.3; P=0.002). The elevated revision risk was particularly marked in patients who received constrained prostheses (13.3% vs. 5.7%, P=0.014) but was also significant in unconstrained implants (8.4% vs. 7.7%, P=0.029). Among patients with osteotomy or osteosynthesis, infection was the predominant reason for revision (27%, P=0.045 compared to other causes), while in the control group both infection (18%) and loosening (13.7%; P=0.031 for distribution) were frequent. Despite the increased revision risk, the overall mortality rate at eight years was similar between the two groups (15.6% vs. 16.1%, P=0.91).

Discussion and conclusion: A history of osteotomy or osteosynthesis significantly increases the risk of TKA revision, primarily driven by infection, without affecting long-term survival. This elevated revision risk is observed in both constrained and unconstrained prostheses; however, the effect appears to be more pronounced in constrained designs, likely reflecting the greater mechanical demands and complexity associated with these implants. As a result, meticulous preoperative planning, implant selection, and infection prophylaxis are crucial in this high-risk population.