AANA Lab Course 913 - Advanced Knee Course-It’s Not Over_ TKA Outcomes Following Ligament, Osteotomy, and Cartilage Surgery Faculty Lecture

It’s Not Over_ TKA Outcomes Following Ligament, Osteotomy, and Cartilage Surgery Faculty Lecture_ Christopher W. Uggen, MD

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This presentation by Dr. Christopher Uggen discusses total knee arthroplasty (TKA) outcomes following prior ligament reconstructions, osteotomies, and cartilage surgeries. Drawing on multiple studies and clinical experience, key considerations and results are highlighted to guide surgeons in managing these complex cases.<br /><br />Patients undergoing TKA after ligament surgery often face challenges such as ligament laxity, retained hardware, bone loss, and may require increased implant constraint, stems, and augments. In a study of 59 patients (mean age 53, mean follow-up 5.4 years) matched 2:1 with controls, 15-year revision-free survival was significantly lower (42% vs 94%) in the ligament surgery group, with higher rates of reoperation (24% vs 6%), instability, infection, and stiffness. Knee Society Scores (KSS) improved similarly but with a trend toward lower functional scores.<br /><br />In 207 patients receiving TKA after high tibial osteotomy (HTO), mostly closing wedge types, mean follow-up was 8 years. Survivorship was approximately 90% at 10 years with a 6% aseptic revision rate. Complications included instability, loosening, and periprosthetic fractures. A common radiographic finding after opening wedge HTO was patella baja/infera, requiring specific surgical techniques such as superior patellar component placement and adjusting joint line height.<br /><br />For TKA after osteochondral allograft (OCA) surgery (35 patients, mean age 48, mean follow-up 9.2 years), 10-year survivorship was 74%, with a 31% revision rate within 10 years. Worse outcomes correlated with younger patients and a higher number of prior surgeries.<br /><br />Overall, most patients do well with TKA following prior ligament, osteotomy, and cartilage procedures. Surgeons should manage patient expectations, allocate additional operative time, and be prepared with specialized equipment including screw removal sets, coring reamers, bone grafts, cement, stems, and implants offering increased constraint. Careful preoperative planning and familiarity with technical pearls improves outcomes in these challenging cases.

Keywords

total knee arthroplasty

ligament reconstruction

osteotomy

cartilage surgery

TKA outcomes

revision-free survival

knee society scores

patella baja

osteochondral allograft

surgical complications