Complication and Reoperation Rates of Post-Distal Femoral Osteotomy Total Knee Arthroplasty versus Primary Total Knee Arthroplasty: Matched Cohorts from a Nationwide Database

J Arthroplasty. 2026 Jun 29:S0883-5403(26)00700-X. doi: 10.1016/j.arth.2026.06.073. Online ahead of print.

ABSTRACT

BACKGROUND: Distal femoral osteotomy (DFO) can be indicated for young patients to correct malalignment and prevent joint overload. Progressive arthritis can require total knee arthroplasty (TKA) after DFO. While primary TKA has reliable outcomes, the perioperative risks associated with post-DFO TKA remain uncertain. We aimed to compare the outcomes and complications between patients who underwent TKA after previous DFO versus primary TKA.

METHODS: A national database was analyzed between the years 2010 and 2022. Our cohort included 606 patients who had TKA after DFO and 1,817 patients who underwent primary TKA. Patients who underwent primary TKA were matched in a 3:1 ratio based on age, sex, and Charlson comorbidity index (CCI) to patients who underwent TKA after DFO. The incidence of revision surgery within two years and postoperative complications within ninety days was compared between groups.

RESULTS: Patients who had a post-DFO TKA had a four times higher risk of experiencing a postoperative infection (3.80 versus 0.39%, P < 0.0001) or hematoma (1.32 versus 0.28%, P < 0.006) after knee arthroplasty compared to primary TKA patients, as well as an increased risk of aseptic loosening and blood transfusion. There was also an increased risk of revision surgery among patients who had a prior DFO, at 7.43 versus 2.26% (P < 0.0001).

CONCLUSION: Patients who undergo TKA after prior DFO are at increased risk of postoperative complications and revision surgery compared to primary TKA patients. Future studies should investigate whether recent technical progress has improved the risk profile for TKA after DFO.

PMID:42373026 | DOI:10.1016/j.arth.2026.06.073