Related Experiment Video
Updated: Sep 4, 2026
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Periarticular Hardware Retention Does Not Increase Reoperation Risk in Conversion Total Knee Arthroplasty
Puthi Tantikosol1, Rit Apinyakul2, Henry J Wong3
1Institute of Orthopaedics, Lerdsin General Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand.
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 the 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 the 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, length of stay, complications, and patient-reported outcome measures (University of California, Los Angeles 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). Length of stay and complication rates also varied across groups (P < 0.05). The patient-reported outcome measures at one and two years showed minor differences, with lower improvements in VR-12 Mental Scores and University of California, Los Angeles scores in the major hardware group at one year (P = 0.034 and P = 0.016, respectively).
Conclusions:
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 2-year patient-reported outcomes.
Level Of Evidence:
Level III, retrospective comparative study.