Knee Arthroplasty After Subchondroplasty: Early Results, Complications, and Technical Challenges

Calcium phosphate bone substitutes (CPBS) are commonly used to augment and repair bone voids and defects after fractures around the knee joint. The purpose of this study was to determine whether prior arthroscopic application of a CPBS, for repair of magnetic resonance imaging-identified subchondral fractures associated with osteoarthritis (procedure referred to as subchondroplasty) adversely affected the performance and/or outcome of subsequent knee arthroplasty.

Twenty-two patients who had arthroscopic repair of a periarticular fracture combined with use of a CPBS who later had knee arthroplasty were identified. Average follow-up for study patients was 23.5 months (range 12-52 months). These patients were matched demographically and for follow-up duration in a 2:1 ratio to a group of control subjects undergoing arthroplasty who had not undergone prior surgery.

Technical challenges related to surgical performance, clinical outcomes, and complications were determined for both the groups. At most recent follow-up, study patients had an average Oxford score of 40.6 (range, 25-48) compared with control subjects with an average score of 40.1 (range, 12-48). There was no difference in complications or surgical complexity between groups, and only standard primary components were used.

The results of our study suggest that prior arthroscopic repair combined with CPBS of periarticular fractures around the knee does not compromise the early outcomes and surgical performance or increase complications related to subsequent arthroplasty. However, longer follow-up of these patients is warranted to confirm that implant durability remains uncompromised.