Conversion Total Knee Arthroplasty in Patients Who Have Periarticular Hardware: One Operation May Be Enough

Patients undergoing total knee arthroplasty (TKA) not infrequently have periarticular hardware in place from prior surgical intervention(s). The optimal management of hardware around the knee is not known, with some surgeons preferring simultaneous removal while others stage hardware removal and TKA. This study compared outcomes in patients with hardware in place who underwent simultaneous or staged management of the hardware and TKA.

This retrospective study included 266 patients undergoing conversion TKA between 2000 and 2023. Simultaneous hardware removal at the time of TKA was performed in 170 patients, while 96 patients underwent staged procedures. Primary outcomes included 90-day postoperative infection and postoperative complications. Hardware removal was categorized as major hardware (plate and intramedullary nail) versus minor hardware (screw, pin, staple, and button). There were no statistically significant differences in patient age, sex, body mass index, or comorbidities between the two cohorts.

Patients with previous infections were more likely to undergo a staged procedure (P = 0.002), with no significant difference in infection rate between the staged cohort (6.25%) and simultaneous cohort (2.35%) (P = 0.176). The overall rate of TKA complications was also not significantly different between groups (13.5% simultaneous, 20.8% staged, P = 0.167). Simultaneous procedures were more likely to involve minor hardware removal (52.9%), while staged procedures more often involved major hardware removal (67.7%) (P < 0.001).

Removal of hardware and performance of TKA in two separate operations may not be necessary in all patients. Patients with prior or active infection around the knee may be better candidates for staged hardware removal and conversion TKA. Further studies with larger cohorts are needed to validate these findings and better standardize the surgical approach in this setting.