JOA - 2026-09-02 - Journal Article
Periarticular Hardware Retention does not Increase Reoperation Risk in Conversion Total Knee Arthroplasty.
Tantikosol P, Apinyakul R, Wong HJ, Amanatullah DF, Huddleston JI, Maloney WJ, Goodman SB
Topics
Key Takeaway
Retained periarticular hardware during conversion TKA did not increase reoperation risk (Fine-Gray p=0.162) despite significantly higher operative time and blood loss in the major hardware group.
Summary Depth
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Summary
This retrospective cohort study compared reoperation risk and perioperative outcomes among 320 patients undergoing conversion or primary TKA stratified by hardware burden: no hardware (n=171), minor hardware (n=90), and major hardware (n=59). Risk-adjusted Fine-Gray subdistribution hazard modeling showed no significant difference in reoperation risk across groups (p=0.162). Major hardware retention was associated with significantly greater operative time and blood loss (p<0.001) and transiently lower VR-12 Mental and UCLA Activity scores at one year (p=0.034 and p=0.016), with differences not persisting at two years.
Key Limitation
Retrospective design with a heterogeneous hardware classification system limits generalizability and reproducibility of the minor vs. major hardware distinction across institutions.
Original Abstract
BACKGROUND
Total knee arthroplasty (TKA) in the setting of retained periarticular hardware presents technical challenges and may influence surgical complexity and outcomes. This study aimed to evaluate whether hardware retention at the time of conversion TKA impacts reoperation risk, perioperative outcomes, and patient-reported outcome measures.
METHODS
A retrospective cohort study was conducted of 320 patients who underwent conversion or primary TKA between 2009 and 2019. Patients were categorized into three groups: no retained hardware (n = 171), retained "minor" hardware (n = 90), and retained "major" hardware (n = 59), based on intraoperative complexity. The primary outcome was risk of reoperation and was assessed using a risk-adjusted Fine-Gray subdistribution hazard model that adjusted for death as a competing event. The secondary outcomes included operative time, blood loss, lengths of stay, complications, and patient-reported outcome measures (University of California, Los Angeles (UCLA) Activity Score, Veterans RAND 12-Item (VR-12) Health Survey Physical and Mental Component Scores) were assessed using univariate tests.
RESULTS
There were no significant differences in the risk of reoperation among the three groups (multivariable Fine-Gray analysis: P = 0.162). Operative time and blood loss were significantly higher in the major hardware group (P < 0.001). Lengths of stay and complication rates also varied across groups (P < 0.05). The PROMs at one and two years showed minor differences, with lower improvements in VR-12 Mental Scores and UCLA scores in the major hardware group at one year (P = 0.034 and P = 0.016, respectively).
CONCLUSION
While periarticular hardware retention in conversion TKA was associated with increased operative time, blood loss, and early complications, especially with plates or intramedullary nails, it was not associated with higher reoperation rates or two-year patient-reported outcomes.