Does Timing of Hindfoot Reconstruction Before or after Primary Total Knee Arthroplasty Impact Reoperation Rates?

Category: Hindfoot; Other Introduction/Purpose: Total knee arthroplasty (TKA), ankle arthrodesis/arthroplasty, and hindfoot arthrodesis are effective procedures in treating end-stage osteoarthritis and deformity of the knee and hindfoot, respectively. Risk of reoperation remains a significant complication associated with these major lower extremity surgeries. Our study aimed to evaluate revision/reoperation rates and etiologies in patients undergoing staged ipsilateral TKA and hindfoot reconstruction (HFR). Methods: A retrospective review identified 162 patients undergoing ipsilateral TKA and HFR procedures between 2000 and 2022. Groups were stratified according to their index surgery: TKA first (n=81) versus HFR first (n=81). Reoperations rates, complications, and indications were compared via descriptive statistics. Mean follow-up was 4 years from the second surgery. Results: For the TKA first cohort, the overall rate of any reoperation was 28% (23/81), including a significantly higher rate of HFR than TKA reoperations (22% vs. 7%, respectively, p< 0.01). The most common etiology for HFR reoperation was arthrodesis nonunion (8/18, 44%) whereas for reoperation indication for TKA was evenly divided between instability, aseptic loosening, and patellar dysfunction. For the HFR first cohort, the overall rate of any reoperation was 16% (13/81), including similar rates of HFR and TKA reoperations (9% and 10%, respectively, p=0.4). The most common etiologies of HFR and TKA reoperations after F&A surgery first were adjacent joint disease (6/7, 86%) and patellar-related complications (4/8, 50%), respectively. Conclusion: Reoperation after a HFR appears to be higher when an ipsilateral TKA is performed first, primarily due to arthrodesis nonunion. Our series represents a first report of the temporal relationship between TKA and ankle/hindfoot reconstruction.