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Higher revision rates in patients with preoperative contralateral pes planovalgus deformity following total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to compare the incidence of revision in those with pes planovalgus deformity to those without using a large national database. Given the reciprocal changes in lower extremity alignment associated with planovalgus foot deformity, it has been suggested that patients with this deformity has worse outcomes following total knee arthroplasty (TKA).

Methods

A retrospective cohort analysis of patients undergoing elective TKA was conducted using the PearlDiver database. Patients were stratified into three cohorts: those without pes planovalgus, patients with ipsilateral or bilateral pes planovalgus relative to the TKA, and patients with contralateral pes planovalgus. Patients with prior foot reconstructive surgery were excluded. The cohorts were each matched to those without pes planovalgus. Bivariate analysis was performed comparing 90-day medical complications and 2- and 4-year revisions following TKA. An adjusted number needed to be exposed for one additional person to be harmed (NNEH) was calculated using the adjusted odds ratio (OR) and unexposed event rate.

Results

Following matched analysis, those with contralateral pes planovalgus had similar odds (OR 3.41; 95% CI 0.93–12.54; p = n.s.) for aseptic revision within 2 years but significantly higher odds (OR 3.35; 95% CI 1.08–10.41; p = 0.03) within 4 years when compared to those without a pes planovalgus deformity. Within 4 years, there was no significant difference in the incidence of aseptic revision (p = n.s.) in patients with ipsilateral/bilateral pes planovalgus. No patients in any cohort underwent septic revision within 4 years of TKA.

Conclusion

This study found that patients with contralateral pes planovalgus deformity had higher odds of aseptic revision within 4 years following primary TKA in a national database, suggesting that the change in gait kinematics associated with this deformity could possibly be associated with increased revision rates.

Level of evidence

Level III.

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Abbreviations

CCI:

Charlson comorbidity index

CI:

Confidence interval

CPT:

Current procedural terminology

ICD:

International classification of diseases

IRB:

Institutional review board

NNEH:

Number needed to be exposed for one additional person to be harmed

OR:

Odds ratio

TKA:

Total knee arthroplasty

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA

    Zachary C. Pearson, Andrew B. Harris, Amil R. Agarwal, R. Timothy Kreulen, Uzoma Ahiarakwe & Savyasachi C. Thakkar

  2. Department of Orthopaedic Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA

    Jalen Martin

  3. Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    Gregory J. Golladay

Authors
  1. Zachary C. Pearson
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  2. Andrew B. Harris
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  3. Amil R. Agarwal
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  4. R. Timothy Kreulen
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  5. Jalen Martin
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  6. Uzoma Ahiarakwe
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  7. Gregory J. Golladay
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  8. Savyasachi C. Thakkar
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Contributions

ZCP: conception, design, data acquisition and analysis, interpretation of data, drafting original manuscript, and revising manuscript; ABH: conception, design, interpretation of data, and revising manuscript; ARA: conception, design, data acquisition and analysis, interpretation of data, drafting original manuscript, and revising manuscript; RTK: interpretation of data, drafting original manuscript, and revising manuscript; JM: conception and drafting original manuscript; UA: conception and revising manuscript; GJG: interpretation of data and revising manuscript SCT: interpretation of data and revising manuscript.

Corresponding author

Correspondence to Zachary C. Pearson.

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Conflict of interest

Zachary Pearson, Andrew Harris, Amil Agarwal, R. Timothy Kreulen, Jalen Martin, and Uzoma Ahiarakwe declare that they have no conflict of interest. Gregory Golladay reports leadership roles with AAOS, the Virginia Orthopaedic Society, and the Journal of Arthroplasty and royalties from Stryker and Arthroplasty Today. Savyasachi Thakkar reports leadership roles with AAOS, Arthroplasty Today, and the Journal of Arthroplasty and unpaid consultant work with OrthoAlign and KCL.

Ethical approval

Our institution’s IRB judged this study to be exempt from IRB review.

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Not applicable.

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Pearson, Z.C., Harris, A.B., Agarwal, A.R. et al. Higher revision rates in patients with preoperative contralateral pes planovalgus deformity following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 31, 4920–4926 (2023). https://doi.org/10.1007/s00167-023-07520-x

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  • DOI: https://doi.org/10.1007/s00167-023-07520-x

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