Total knee arthroplasty in post-traumatic versus degenerative osteoarthritis: a meta-analysis of outcomes

Total knee arthroplasty (TKA) in post-traumatic osteoarthritis (PTOA) presents challenges that are not encountered in primary osteoarthritis (OA) cases. Given the inconsistent evidence regarding the safety and efficacy of TKA after PTOA, this meta-analysis, seeks to provide a clear understanding of the additional risks that are associated in PTOA patients.

Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1-20) were accessed and explored until January 2025. The extracted data consisted of complications (overall complications, mechanical complications, wound-related complications, prosthetic joint infection (PJI), instability, aseptic loosening, and medical complications), readmissions, manipulation under anesthesia (MUA), reoperations, and surgery-related parameters (operative time, estimated blood loss (EBL), and length of stay (LOS)).

Seventeen retrospective articles were included in the meta-analysis, including 342,584 patients, with 7936 in the PTOA group and 334,648 in the OA group. PTOA patients were found to have higher rates of overall complications (Odds Ratio = 3.41; 95% CI 2.30-5.06, p < .001) as well as specific complications, readmissions (Odds Ratio = 2.04; 95% CI 1.11-3.76, p = 0.02), MUA (Odds Ratio = 4.45; 95% CI 1.90-10.41, p < .001), and reoperations (Odds Ratio = 2.30; 95% CI 1.72-3.07, p < .001) than OA patients. Furthermore, PTOA patients had a longer operative time (Mean difference = 11.39 min; 95% CI 7.13-15.85, p < .001) and more EBL (Mean difference = 114.47 ml; 95% CI 22.33-206.61, p < .001) while having a shorter LOS (Mean difference =  - 0.24 days; 95% CI - 0.38- - 0.10, p < .001).

Compared to patients with OA, patients with PTOA had a higher rate of overall complications and specific surgical complications, readmissions, MUA, reoperations, a lengthier operative time, and more EBL. However, they had a shorter LOS compared to OA patients.