Conversion Total Knee Arthroplasty After Failed Osteochondral Allograft Reconstruction: Similar Functional Performance With Lower Patient Satisfaction

Background: This study presents surgical techniques used in conversion total knee arthroplasty (cTKA) following early failure of large osteochondral allograft joint replacement and compares postoperative patient reported outcomes measures (PROMs) and satisfaction scores with a contemporary primary total knee arthroplasty (pTKA) cohort.Methods: We retrospectively evaluated 25 consecutive cTKA patients (26 procedures) to define the utilized surgical techniques, radiographic disease severity, preoperative and postoperative PROMs (visual analog scale [VAS] pain, knee injury and osteoarthritis outcome score for joint replacement [KOOS-JR], University of California Los Angeles Activity), expected improvement and postoperative satisfaction (5-point Likert), and reoperations in comparison with an age and body mass index propensity matched cohort of 50 pTKA performed for osteoarthritis (52 procedures).Results: Revision components were used in 12 cTKA cases (46.1%), with 4 cases requiring augmentation (15.4%), and 3 cases utilizing varus-valgus constraint (11.5%). While no significant differences were noted in expectation level or in other PROMs, mean patient reported satisfaction was lower in the conversion group (4.4 & PLUSMN; 1.1 versus 4.8 & PLUSMN; 0.5 points, P = .02). High cTKA satisfaction was associated with a higher postoperative KOOS-JR (84.4 versus 64.2 points, P = .01) and a trend towards higher University of Cal-ifornia Los Angeles activity (6.9 versus 5.7 points, P = .08). Four patients in each group underwent manipulation (15.3 versus 7.6%, P = .42), and 1 pTKA patient was treated for early postoperative infection (0 versus 1.9%, P = 1.0).Conclusion: cTKA following failed biological replacement was associated with similar postoperative improvement as in pTKA. Lower patient-reported cTKA satisfaction was associated with lower post-operative KOOS-JR scores. Published by Elsevier Inc.

Automated summary

This study compares surgical techniques used in conversion total knee arthroplasty (cTKA) after early failure of large osteochondral allograft joint replacement and evaluates postoperative patient reported outcomes measures (PROMs) and satisfaction scores compared to a primary total knee arthroplasty (pTKA) cohort. The results showed that cTKA had similar postoperative improvement as pTKA, but lower patient-reported satisfaction was associated with lower post-operative KOOS-JR scores.