Osteoporosis a risk factor for revision surgery after total knee arthoplasty

The first Knee replacement surgery was performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Total knee replacements are one of the most successful procedures in all of medicine to manage knee and knee related injuries however there is a risk of revision surgery in patients who have osteoporosis after total knee arthroplasty (TKA).

A new study compared the 5-year cumulative risk of revision surgery after TKA in patients who have preoperative osteoporosis and found that patients with osteoporosis had a two-fold increased risk for revision for periprosthetic fracture at 5 years after total knee arthroplasty compared with patients without osteoporosis. The findings of the study are published in The Journal of Arthoplasty.

The key findings of the study are

• The 5-year rate of all-cause revision surgery was higher for patients who had osteoporosis (Hazards Ratio (HR) 1.1, 95% Confidence interval (CI):1.0-1.2), however, the highest risk of revision surgery was seen for periprosthetic fracture (HR 1.8, 95% CI:1.6-2.1).

• Patients who had osteoporosis also had elevated risk of revision surgery for periprosthetic joint infection (PJI) (HR 1.2, 95% CI:1.1-1.3) and aseptic loosening (HR 1.2, 95% CI:1.1-1.3).

• Osteoporosis was independently associated with PJI and aseptic loosening at a higher rate in obese patients.

Researchers concluded that “When examining all patients in unadjusted survival analysis, those who had osteoporosis have a marginally lower risk of all-cause revision surgery after TKA. However, after controlling for age, sex and comorbidities, patients who had osteoporosis have a nearly 2-fold increased risk of 5-year revision for PPF after TKA, and mildly increased risk of revision for all-causes, aseptic loosening, and PJI. Obesity may also modulate this association. Future studies should determine the extent to which treatment of osteoporosis modifies these postoperative outcomes.”

Reference: Andrew B. Harris, MD , Mark A. Lantieri, MD Et al; Osteoporosis and Total Knee Arthroplasty: Higher 5-Year Implant-Related Complications; October 29, 2023 DOI: https://doi.org/10.1016/j.arth.2023.10.045