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Staged vs Concurrent Hardware Removal During Conversion Total Knee Arthroplasty.

Evan J Smith1, Akhil Katakam1, Hayden N Box2

  • 1Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA.

The Journal of Arthroplasty
|July 23, 2020
PubMed
Summary
This summary is machine-generated.

For conversion total knee arthroplasty (TKA), removing periarticular hardware concurrently or in a staged manner yields similar outcomes. The approach to hardware removal should be individualized, regardless of hardware burden.

Keywords:
conversionhardware removalstagedtotal knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Arthroplasty
  • Biomaterials & Implants

Background:

  • Conversion total knee arthroplasty (TKA) with existing periarticular hardware presents challenges.
  • Increased resource utilization, complications, and revisions are potential risks.
  • Optimal strategies for hardware removal during conversion TKA are not well-defined.

Purpose of the Study:

  • To compare outcomes of conversion TKA with hardware removal performed in a staged versus concurrent manner.
  • To evaluate the impact of hardware removal timing on complications, reoperations, and revisions.
  • To assess outcomes based on hardware type and complexity.

Main Methods:

  • Retrospective analysis of 155 conversion TKA cases.
  • Comparison of staged (n=45) versus concurrent (n=110) hardware removal.
  • Evaluation of patient demographics, surgical data, complications, reoperations, and revisions; subgroup analysis by hardware type (major/minor).

Main Results:

  • No significant differences in age, sex, BMI, or comorbidities between staged and concurrent groups.
  • Comparable rates of complications, reoperations, and revisions at 90 days, 1, 2, and 4 years.
  • Staged removal was associated with prior fracture surgery and major hardware removal, and less often a single-incision procedure.

Conclusions:

  • Neither staged nor concurrent hardware removal offers a distinct advantage for conversion TKA outcomes.
  • The presence and burden of periarticular hardware do not influence the choice of removal strategy.
  • A case-by-case, individualized approach is recommended for hardware removal during conversion TKA.