ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2026
Increased risk of knee osteoarthritis progressing to total knee arthroplasty following patella fractures: an age stratified population analysis.
Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionPatella fractures are articular injuries that can alter knee biomechanics, disrupt joint contact forces, and promote cartilage degeneration. However, progression to reconstructive surgery is not fully characterized. This study investigates the risk of progression to total knee arthroplasty (TKA) following patella fractures and assesses whether initial operative versus nonoperative management impacts this risk.
methodsWe retrospectively analyzed TKA progression in patients with patella fractures using synthetic data from a large Level I academic trauma center (1996-2024). Patients were identified by historic diagnostic codes for patella fractures and TKA. Age-stratified TKA rates were compared to published national data, and indirect standardization was used to calculate the age-adjusted standardized incidence ratio (SIR), risk difference (RD), and attributable risk percent (AR%).
resultsAmong 3212 native patella fractures, 263 patients (8.2%) later underwent TKA. The mean age at fracture was 58.1 years (SD 17.5) with a mean time to TKA of 4.1 years (SD 4.9). The SIR for TKA was 1.6 (95% CI 1.3-1.9), RD 3.1%, and AR% 37.2%. In the 406 operatively treated fractures (mean age 55.3 years, SD 18.6; 60.8% female), TKA occurred in 5.4% (SIR 1.4, 95% CI 0.9-2.2), compared to 8.6% in the 2,806 nonoperatively treated fractures (mean age 58.5 years, SD 17.4; 61.8% female; SIR 2.1, 95% CI 1.8-2.3) (p = 0.04).
conclusionIndividuals with patella fractures face an increased lifetime risk of advanced joint degeneration and subsequent TKA compared to the general population, with nonoperative treatment linked to a higher risk than operative management. Further analysis of initial injury patterns, radiographic findings, and patient factors are in need for further research to understand and validate these findings.
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