Dohse Nicolas M, Larwa Joseph A, Moses Alex M, Herbel Cole, Lopez Ramiro, Ledford Cameron K, Haupt Edward T
UF Health Jacksonville, Jacksonville, FL, USA.
Mayo Clinic Jacksonville, Jacksonville, FL, USA.
Foot Ankle Orthop. 2025 Mar 17;10(1):24730114251318735. doi: 10.1177/24730114251318735. eCollection 2025 Jan.
Total knee arthroplasty (TKA) and hindfoot reconstruction (HFR) are often used to treat osteoarthritis and deformities of the knee and hindfoot. Despite the proven clinical effectiveness of these treatments, postoperative patient dissatisfaction is high. The knee and ankle are adjacent joints in the lower extremity, and angular deformity of either joint is known to affect positioning of the anatomical and mechanical axes of the entire limb. Although it is understood this relationship exists, there are limited studies evaluating outcomes of ipsilateral procedures on patients with pathologies of both knee and hindfoot. This article aims to evaluate whether TKA or TAA/HFR sequencing influences postoperative outcome. The study hypothesis is that TKA prior to TAA/HFR results in lower reoperation.
A retrospective chart review using () codes was performed encompassing all patients who underwent TKA in conjunction with a variety of hindfoot procedures. All procedures were performed at a single academic medical site between 2000 and 2022. Exclusion criteria included those patients not having both ipsilateral TKA and hindfoot procedures or those lacking conclusive postoperative data. The primary outcome of this study was to identify significant reoperations such as adjacent joint arthrodeses, hardware removal, or unrelated ipsilateral limb surgery. Secondary outcomes included identification of revision procedures including revision TKA or revision HFR and other postoperative complication data.
This study included 158 patients, with 79 patients in each group. In the TKA-first group, the mean follow-up time was 10.24 years (range, 1.10-22.42 years) and the mean time to HFR was 5.94 years. In the HFR-first group, the mean follow-up time was 9.01 years (range, 1.01-23.55 years) and the mean time to TKA was 5.51 years.In patients who underwent TKA first, the mean reoperation rate was not significantly different from those who underwent HFR/TAA first, 30.4% vs 19.0% ( = .12). In patients who underwent TKA first, the rate of HFR reoperations (22.78%) was greater than TKA reoperations (7.59%) ( < .01). The revision rate was higher in the TKA-first group (17.7%) when compared to the HFR-first group (6.3%) ( = .03). Additionally, there were more revision HFR procedures in the TKA-first group (9/79) compared with the HFR-first group (1/79) ( .009).
In contrast to the study hypothesis that TKA first would result in less reoperation, our study found that TAA or HFR performed before TKA had an overall lower complication rate. However, these findings should be interpreted cautiously as the sample size was limited.
Level III, retrospective cohort study.
全膝关节置换术（TKA）和后足重建术（HFR）常用于治疗膝关节和后足的骨关节炎及畸形。尽管这些治疗方法已被证实具有临床有效性，但术后患者满意度仍较低。膝关节和踝关节是下肢相邻的关节，已知任何一个关节的角畸形都会影响整个肢体的解剖和机械轴定位。虽然人们了解这种关系的存在，但评估同侧手术对膝关节和后足均有病变患者的疗效的研究有限。本文旨在评估TKA或TAA/HFR的手术顺序是否会影响术后结果。研究假设是在TAA/HFR之前进行TKA会降低再次手术率。
使用（）编码进行回顾性病历审查，纳入所有接受TKA并同时进行各种后足手术的患者。所有手术均于2000年至2022年在单一学术医疗中心进行。排除标准包括未同时进行同侧TKA和后足手术的患者或缺乏确凿术后数据的患者。本研究的主要结局是确定诸如相邻关节融合、取出内固定装置或无关的同侧肢体手术等重大再次手术。次要结局包括确定翻修手术，包括翻修TKA或翻修HFR以及其他术后并发症数据。
本研究纳入158例患者，每组79例。在TKA先行组中，平均随访时间为10.24年（范围1.10 - 22.42年），至HFR的平均时间为5.94年。在HFR先行组中，平均随访时间为9.01年（范围1.01 - 23.55年），至TKA的平均时间为5.51年。在先行TKA的患者中，平均再次手术率与先行HFR/TAA的患者相比无显著差异，分别为30.4%和19.0%（P = 0.12）。在先行TKA的患者中，HFR再次手术率（22.78%）高于TKA再次手术率（7.59%）（P < 0.01）。与HFR先行组（6.3%）相比，TKA先行组的翻修率更高（17.7%）（P = 0.03）。此外，与HFR先行组（1/79）相比，TKA先行组有更多的翻修HFR手术（9/79）（P = 0.009）。
与TKA先行会导致较少再次手术的研究假设相反，我们的研究发现TKA之前进行TAA或HFR总体并发症发生率更低。然而，由于样本量有限，这些结果应谨慎解读。
III级，回顾性队列研究。
